Digestive Endoscopy 2015; 27: 397–401
Letters, Techniques and Images
Capsule endoscopy is safe in patients with cardiac pacemakers and implantable cardioverter defibrillators In our opinion, small errors and incompleteness crept into the article by Stanich et al.1 For potential induced interference, the authors describe cardiac pacemakers (PM) or other implantable cardiac devices as a relative contraindication against capsule endoscopy (CE), citing the American guidelines of CE.2 This does not take into consideration the European guidelines of CE stating ‘VCE [video capsule endoscopy] is not contraindicated in patients with a PM or implantable cardiac defibrillator (ICD)’.3 Further, the authors cited the study of Dubner et al.4 showing an inappropriate shock during in vitro testing. Our study investigating CE and the same type of ICD,5 which did not reveal any interference, is not mentioned by the authors. We observed no interference between CE devices (Given Imaging (Yoqneam, Israel) and Olympus Medical Systems Corp., Tokyo, Japan), the PillCam COLON device (Given Imaging), and ICD. Another point of criticism of the article by Stanich et al.1 is the incomplete description of the type and programmed modes of the devices used. The authors mentioned an ‘implantable hemodynamic monitoring device’ without iteming the name or any technical specifications of the respective device. Moreover, in one patient with a PM, the mode was changed from VVIR to VOOR and, in another patient, an ICD was deactivated. There is a small risk (0.001%) of inducing ventricular fibrillation in ventricular stimulation by PM programmed to an interference mode. Relating to the ICD, the authors did not mention whether the sensing function was turned off or whether the mode was also changed. The authors concluded that their findings support the need for further studies to confirm the effectiveness and safety of VCE in patients with implantable cardiac devices. This statement does not consider the results of our in vitro study5 which observed no interference between the CE device and the PM and ICD, despite their close topographical proximity in the test setting.
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Dirk Bandorski,1 Harilaos Bogossian2 and Reinhard Hoeltgen3 1 Medical Clinic II, University Giessen, Giessen, 2 Medizinische Klinik III, Klinikum Luedenscheid, Universität Witten-Herdecke, Luedenscheid and 3Medical Clinic III, St. Agnes Hospital Bocholt, Bocholt, Germany
REFERENCES 1 Stanich PP, Kleinman B, Betkerur K, Oza NM, Porter K, Meyer MM. Video capsule endoscopy is successful and effective in outpatients with implantable cardiac devices. Dig. Endosc. 2014; 26: 726–30. 2 Wang A, Banerjee S, Barth BA et al. Wireless capsule endoscopy. Gastrointest. Endosc. 2013; 78: 805–15. 3 Ladas SD, Triantafyllou K, Spada C et al. European Society of Gastrointestinal Endoscopy (ESGE): Recommendations (2009) on clinical use of video capsule endoscopy to investigate smallbowel, esophageal and colonic diseases. Endoscopy 2010; 42: 220–7. 4 Dubner S, Dubner Y, Rubio H, Goldin E. Electromagnetic interference from wireless video-capsule endoscopy on implantable cardioverter-defibrillators. Pacing Clin. Electrophysiol. 2007; 30: 472–5. 5 Bandorski D, Irnich W, Brück M, Kramer W, Jakobs R. Do endoscopy capsules interfere with implantable cardioverterdefibrillators? Endoscopy 2009; 41: 457–61.
Metastasis of lung cancer to the gastrointestinal tract, presenting with a volcano-like ulcerated mass The most common primary malignancy associated with metastasis to the gastrointestinal tract is lung cancer. Metastasis of lung cancer to the gastrointestinal tract is extremely rare. Within the gastrointestinal tract, the small bowel is the most common site of metastasis from primary lung cancer. The clinical prevalence of symptomatic gastric and colonic metastasis is extremely rare. We present a case of multiple gastrointestinal metastasis from lung carcinoma.1,2 A 54-year-old man underwent laparoscopic right upper lobectomy for primary right lung cancer and received chemotherapy. Pathological diagnosis was poorly differentiated squamous cell carcinoma (Fig. 1A). Immunohistochemical analysis of the lung cancer was positive for p63, a nuclear marker specific to squamous cell carcinoma. He was referred to our endoscopy center because of abdominal pain and anemia. Physical examination revealed pallor of the conjunctiva. Computed tomography demonstrated small polypoid lesions in the stomach and colon, and swelling of the lymph nodes as well as multiple liver metastasis. Esophagogastroduodenoscopy demonstrated multiple polypoid lesions with an irregular ulcer in the antrum (Fig. 2A). Colonoscopy showed polypoid lesions with an irregular ulcer in the cecum (Fig. 2B). Histological examination of gastric (Fig. 1B) and
© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society
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Letters, Techniques and Images
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Digestive Endoscopy 2015; 27: 397–401
REFERENCES 1 Sakai H, Egi H, Hinoi T et al. Primary lung cancer presenting with metastasis to the colon. World J. Surg. Oncol. 2012; 10: 127. 2 Kim SY, Ha HK, Park SW et al. Gastrointestinal metastasis from primary lung cancer: CT findings and clinicopathologic features. Am. J. Roentgenol. 2009; 193: 197–201.
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Figure 1 (A) Histology of the lung revealed poorly differentiated squamous cell carcinoma (H&E, magnification ×20). (B) Histology of the stomach revealed poorly differentiated squamous cell carcinoma (H&E, mag. ×40). (C) Histology of the cecal lesion revealed poorly differentiated squamous cell carcinoma (H&E, mag. ×40). (D) Immunohistochemically, the carcinoma cells in the cecum were positive for p63 (mag. ×40).
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Migration of gastrostomy site: Rare complication of percutaneous endoscopic gastrostomy Although percutaneous endoscopic gastrostomy (PEG) is relatively safe and easy to carry out, complications can occur during and after the procedure.1–5 Here, we report a rare case with complications involving a gastrostomy tube. An 82-year-old woman with a history of cerebral hemorrhage underwent PEG using a Safety PEG kit (Boston Scientific Japan, Tokyo, Japan) with the pull technique at the anterior wall of the lower gastric body (Fig. 1A). Esophagogastroduodenoscopy (EGD) showed normal findings in the stomach and duodenum (Fig. 1B). Exchanges of the balloontype (Foley-type) gastrostomy tube had been carried out in an irregular manner with intervals of 1–6 months without using endoscopy. EGD 4 years after initial placement of the gastrostomy revealed a longitudinal ulcer scar extending from the anterior wall of the lower gastric body to the anterior wall of the pylorus ring, with shortening of the lesser curvature of the stomach (Fig. 1C). The internal balloon was placed in the bulbus (Fig. 1D). The ulcer scar of the stomach appeared to continue from the position where gastrostomy
Figure 2 (A) Esophagogastroduodenoscopy demonstrated multiple polypoid lesions with an irregular ulcer in the antrum. (B) Colonoscopy showed multiple polypoid lesions with an irregular ulcer in the cecum.
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colonic lesions revealed poorly differentiated squamous cell carcinoma (Fig. 1C). Immunohistochemically, the carcinoma cells in the stomach and cecum were positive for p63 (Fig. 1D). Recurrence of lung cancer presented with multiple metastasis to the gastrointestinal tract, forming volcano-like ulcerated lesions involving several segments of the gastrointestinal tract.
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Authors declare no conflict of interests for this article. Junichi Miyazaki, Seiichi Hirota and Takashi Abe Endoscopy Center, Takarazuka Municipal Hospital, Takarazuka, Japan doi: 10.1111/den.12412
Figure 1 Endoscopic views of the initial percutaneous endoscopic gastrostomy (PEG). (A) Lower gastric body. (B) Antrum. Endoscopic views 4 years after the initial PEG. (C) Longitudinal ulcer scar extends from the anterior wall of the lower gastric body to the anterior wall of the pyloric ring. (D) The balloon of the internal gastrostomy tube has migrated away from the current gastrostomy site into the duodenum.
© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society
Copyright of Digestive Endoscopy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letters, Techniques and Images
Capsule endoscopy is safe in patients with cardiac pacemakers and implantable cardioverter defibrillators In our opinion, small errors and incompleteness crept into the article by Stanich et al.1 For potential induced interference, the authors describe cardiac pacemakers (PM) or other implantable cardiac devices as a relative contraindication against capsule endoscopy (CE), citing the American guidelines of CE.2 This does not take into consideration the European guidelines of CE stating ‘VCE [video capsule endoscopy] is not contraindicated in patients with a PM or implantable cardiac defibrillator (ICD)’.3 Further, the authors cited the study of Dubner et al.4 showing an inappropriate shock during in vitro testing. Our study investigating CE and the same type of ICD,5 which did not reveal any interference, is not mentioned by the authors. We observed no interference between CE devices (Given Imaging (Yoqneam, Israel) and Olympus Medical Systems Corp., Tokyo, Japan), the PillCam COLON device (Given Imaging), and ICD. Another point of criticism of the article by Stanich et al.1 is the incomplete description of the type and programmed modes of the devices used. The authors mentioned an ‘implantable hemodynamic monitoring device’ without iteming the name or any technical specifications of the respective device. Moreover, in one patient with a PM, the mode was changed from VVIR to VOOR and, in another patient, an ICD was deactivated. There is a small risk (0.001%) of inducing ventricular fibrillation in ventricular stimulation by PM programmed to an interference mode. Relating to the ICD, the authors did not mention whether the sensing function was turned off or whether the mode was also changed. The authors concluded that their findings support the need for further studies to confirm the effectiveness and safety of VCE in patients with implantable cardiac devices. This statement does not consider the results of our in vitro study5 which observed no interference between the CE device and the PM and ICD, despite their close topographical proximity in the test setting.
bs_bs_banner
Dirk Bandorski,1 Harilaos Bogossian2 and Reinhard Hoeltgen3 1 Medical Clinic II, University Giessen, Giessen, 2 Medizinische Klinik III, Klinikum Luedenscheid, Universität Witten-Herdecke, Luedenscheid and 3Medical Clinic III, St. Agnes Hospital Bocholt, Bocholt, Germany
REFERENCES 1 Stanich PP, Kleinman B, Betkerur K, Oza NM, Porter K, Meyer MM. Video capsule endoscopy is successful and effective in outpatients with implantable cardiac devices. Dig. Endosc. 2014; 26: 726–30. 2 Wang A, Banerjee S, Barth BA et al. Wireless capsule endoscopy. Gastrointest. Endosc. 2013; 78: 805–15. 3 Ladas SD, Triantafyllou K, Spada C et al. European Society of Gastrointestinal Endoscopy (ESGE): Recommendations (2009) on clinical use of video capsule endoscopy to investigate smallbowel, esophageal and colonic diseases. Endoscopy 2010; 42: 220–7. 4 Dubner S, Dubner Y, Rubio H, Goldin E. Electromagnetic interference from wireless video-capsule endoscopy on implantable cardioverter-defibrillators. Pacing Clin. Electrophysiol. 2007; 30: 472–5. 5 Bandorski D, Irnich W, Brück M, Kramer W, Jakobs R. Do endoscopy capsules interfere with implantable cardioverterdefibrillators? Endoscopy 2009; 41: 457–61.
Metastasis of lung cancer to the gastrointestinal tract, presenting with a volcano-like ulcerated mass The most common primary malignancy associated with metastasis to the gastrointestinal tract is lung cancer. Metastasis of lung cancer to the gastrointestinal tract is extremely rare. Within the gastrointestinal tract, the small bowel is the most common site of metastasis from primary lung cancer. The clinical prevalence of symptomatic gastric and colonic metastasis is extremely rare. We present a case of multiple gastrointestinal metastasis from lung carcinoma.1,2 A 54-year-old man underwent laparoscopic right upper lobectomy for primary right lung cancer and received chemotherapy. Pathological diagnosis was poorly differentiated squamous cell carcinoma (Fig. 1A). Immunohistochemical analysis of the lung cancer was positive for p63, a nuclear marker specific to squamous cell carcinoma. He was referred to our endoscopy center because of abdominal pain and anemia. Physical examination revealed pallor of the conjunctiva. Computed tomography demonstrated small polypoid lesions in the stomach and colon, and swelling of the lymph nodes as well as multiple liver metastasis. Esophagogastroduodenoscopy demonstrated multiple polypoid lesions with an irregular ulcer in the antrum (Fig. 2A). Colonoscopy showed polypoid lesions with an irregular ulcer in the cecum (Fig. 2B). Histological examination of gastric (Fig. 1B) and
© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society
397
398
A
Letters, Techniques and Images
B
Digestive Endoscopy 2015; 27: 397–401
REFERENCES 1 Sakai H, Egi H, Hinoi T et al. Primary lung cancer presenting with metastasis to the colon. World J. Surg. Oncol. 2012; 10: 127. 2 Kim SY, Ha HK, Park SW et al. Gastrointestinal metastasis from primary lung cancer: CT findings and clinicopathologic features. Am. J. Roentgenol. 2009; 193: 197–201.
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D
Figure 1 (A) Histology of the lung revealed poorly differentiated squamous cell carcinoma (H&E, magnification ×20). (B) Histology of the stomach revealed poorly differentiated squamous cell carcinoma (H&E, mag. ×40). (C) Histology of the cecal lesion revealed poorly differentiated squamous cell carcinoma (H&E, mag. ×40). (D) Immunohistochemically, the carcinoma cells in the cecum were positive for p63 (mag. ×40).
A
B
Migration of gastrostomy site: Rare complication of percutaneous endoscopic gastrostomy Although percutaneous endoscopic gastrostomy (PEG) is relatively safe and easy to carry out, complications can occur during and after the procedure.1–5 Here, we report a rare case with complications involving a gastrostomy tube. An 82-year-old woman with a history of cerebral hemorrhage underwent PEG using a Safety PEG kit (Boston Scientific Japan, Tokyo, Japan) with the pull technique at the anterior wall of the lower gastric body (Fig. 1A). Esophagogastroduodenoscopy (EGD) showed normal findings in the stomach and duodenum (Fig. 1B). Exchanges of the balloontype (Foley-type) gastrostomy tube had been carried out in an irregular manner with intervals of 1–6 months without using endoscopy. EGD 4 years after initial placement of the gastrostomy revealed a longitudinal ulcer scar extending from the anterior wall of the lower gastric body to the anterior wall of the pylorus ring, with shortening of the lesser curvature of the stomach (Fig. 1C). The internal balloon was placed in the bulbus (Fig. 1D). The ulcer scar of the stomach appeared to continue from the position where gastrostomy
Figure 2 (A) Esophagogastroduodenoscopy demonstrated multiple polypoid lesions with an irregular ulcer in the antrum. (B) Colonoscopy showed multiple polypoid lesions with an irregular ulcer in the cecum.
A
B
colonic lesions revealed poorly differentiated squamous cell carcinoma (Fig. 1C). Immunohistochemically, the carcinoma cells in the stomach and cecum were positive for p63 (Fig. 1D). Recurrence of lung cancer presented with multiple metastasis to the gastrointestinal tract, forming volcano-like ulcerated lesions involving several segments of the gastrointestinal tract.
C
D
Authors declare no conflict of interests for this article. Junichi Miyazaki, Seiichi Hirota and Takashi Abe Endoscopy Center, Takarazuka Municipal Hospital, Takarazuka, Japan doi: 10.1111/den.12412
Figure 1 Endoscopic views of the initial percutaneous endoscopic gastrostomy (PEG). (A) Lower gastric body. (B) Antrum. Endoscopic views 4 years after the initial PEG. (C) Longitudinal ulcer scar extends from the anterior wall of the lower gastric body to the anterior wall of the pyloric ring. (D) The balloon of the internal gastrostomy tube has migrated away from the current gastrostomy site into the duodenum.
© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society
Copyright of Digestive Endoscopy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
