□
PICTURES IN CLINICAL MEDICINE
□
Endoscopic Submucosal Dissection for Gastric Arteriovenous Malformation Yuichi Kojima 1, Toshihisa Takeuchi 1, Yutaro Egashira 2 and Kazuhide Higuchi 3 Key words: gastric arteriovenous malformation, AVM, endoscopic submucosal dissection
(Intern Med 55: 3221-3223, 2016) (DOI: 10.2169/internalmedicine.55.7241)
a
b
c
d
Picture 1.
１
Endoscopy Center, Osaka Medical College, Japan, ２ Department of Pathology, Osaka Medical College, Japan and ３ Second Department of Internal Medicine, Osaka Medical College, Japan Received for publication February 7, 2016; Accepted for publication March 4, 2016 Correspondence to Dr. Yuichi Kojima, [email protected]
3221
Intern Med 55: 3221-3223, 2016
DOI: 10.2169/internalmedicine.55.7241
a
c
b
d
Picture 2.
Picture 3.
3222
Intern Med 55: 3221-3223, 2016
DOI: 10.2169/internalmedicine.55.7241
× 100
× 20 Picture 4.
An 87-year-old man consulted our hospital with hematemesis. Esophagogastroduodenoscopy revealed the presence of a submucosal tumor with a small ulcer in the antrum (Picture 1). Contrast-enhanced computed tomography revealed a stained nodular structure (Picture 2a and b). Endoscopic ultrasound showed a low-echoic area in the submucosal layer. An echo-free area was connected with dilated blood vessels on the deeper side (Picture 2c and d). Its color and shape was not typical of a hemangioma. It was therefore diagnosed to be arteriovenous malformation (AVM) for the preoperative diagnosis. Because the lesion was localized in the submucosal layer, endoscopic submucosal dissection (ESD) was selected for the treatment. A feeding blood vessel was cauterized and incised with hot biopsy forceps (Picture 3). Histopathologically, an irregular, nontumorous arterial/venous outgrowth was observed, suggesting AVM (Picture 4). Gastric AVM is relatively rare (1) and it may some-
times cause digestive tract hemorrhage (2). This is the first report in which ESD was selected to treat gastric AVM. The authors state that they have no Conflict of Interest (COI).
References 1. Moore J, Thompson N, Appleman HD, Foley D. Arteriovenous malformations of the gastrointestinal tract. Arch Surg 111: 381389, 1976. 2. Huang C, Lichtenstein D. Nonvariceal upper gastrointestinal bleeding. Gastroenterol Clin North Am 32: 1053-1078, 2003. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).
Ⓒ 2016 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
3223
PICTURES IN CLINICAL MEDICINE
□
Endoscopic Submucosal Dissection for Gastric Arteriovenous Malformation Yuichi Kojima 1, Toshihisa Takeuchi 1, Yutaro Egashira 2 and Kazuhide Higuchi 3 Key words: gastric arteriovenous malformation, AVM, endoscopic submucosal dissection
(Intern Med 55: 3221-3223, 2016) (DOI: 10.2169/internalmedicine.55.7241)
a
b
c
d
Picture 1.
１
Endoscopy Center, Osaka Medical College, Japan, ２ Department of Pathology, Osaka Medical College, Japan and ３ Second Department of Internal Medicine, Osaka Medical College, Japan Received for publication February 7, 2016; Accepted for publication March 4, 2016 Correspondence to Dr. Yuichi Kojima, [email protected]
3221
Intern Med 55: 3221-3223, 2016
DOI: 10.2169/internalmedicine.55.7241
a
c
b
d
Picture 2.
Picture 3.
3222
Intern Med 55: 3221-3223, 2016
DOI: 10.2169/internalmedicine.55.7241
× 100
× 20 Picture 4.
An 87-year-old man consulted our hospital with hematemesis. Esophagogastroduodenoscopy revealed the presence of a submucosal tumor with a small ulcer in the antrum (Picture 1). Contrast-enhanced computed tomography revealed a stained nodular structure (Picture 2a and b). Endoscopic ultrasound showed a low-echoic area in the submucosal layer. An echo-free area was connected with dilated blood vessels on the deeper side (Picture 2c and d). Its color and shape was not typical of a hemangioma. It was therefore diagnosed to be arteriovenous malformation (AVM) for the preoperative diagnosis. Because the lesion was localized in the submucosal layer, endoscopic submucosal dissection (ESD) was selected for the treatment. A feeding blood vessel was cauterized and incised with hot biopsy forceps (Picture 3). Histopathologically, an irregular, nontumorous arterial/venous outgrowth was observed, suggesting AVM (Picture 4). Gastric AVM is relatively rare (1) and it may some-
times cause digestive tract hemorrhage (2). This is the first report in which ESD was selected to treat gastric AVM. The authors state that they have no Conflict of Interest (COI).
References 1. Moore J, Thompson N, Appleman HD, Foley D. Arteriovenous malformations of the gastrointestinal tract. Arch Surg 111: 381389, 1976. 2. Huang C, Lichtenstein D. Nonvariceal upper gastrointestinal bleeding. Gastroenterol Clin North Am 32: 1053-1078, 2003. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).
Ⓒ 2016 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
3223
