image of the week

diagnosis

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Endosonographic image of a duodenal diverticulum using watre filling

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Small pedunculated sigmoid adenoma (low grade); the distorted pattern at the polyp tip does not indicate more severe histopathology

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Close-up image of a Barrett carcinoma on NBI only visible with a cap

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Endosonographic visualization of a distal bile duct carcinoma with echopoor and irregular wall thickening and a small part of the bile duct lumen

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See image of last week – visualization with cap and acetic acid staining – typical Barrett epithelium

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Image of the cardia with questionable small Barrett island – see image next week

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Reddish fundic gland polyp in the stomach (histologically confirmed)

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Slightly prominent appendiceal orifice in cecum

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Distal esophagus in a patient with longstanding achalasia showing erosive changes, probably due to stasis

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Valley Sign of a colon adenoma, first described by Dr. Rex in 2017

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Tubullovillous adenoma.

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BLI highlights the mucosal surface and vascular pattern morphology. In combination with an optical zoom, in vivo diagnosis of a tubular adenoma can be easily achieved

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Carcinoma in a short-segment Barrett’s esophagus

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Submucosal tunnel during a POEM procedure.

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Post-inflammatory polyps in ulcerative colitis imaged with LCI. Identification of dysplasia in those cases can become extremely challenging.

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NET of the rectum imaged with BLI. Although small, the lesion can be clearly demarked for subsequent endoscopic resection.

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Invasive amebiasis in the colon, with ulcerations in the right colon.

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Multiple vessels after polypectomy. Not that endoscopic clipping is not always necessary.

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Mucomyotomy of Zenker’s diverticulum. Muscle fibers are already clearly exposed.

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Gastric cancer imaged with BLI for visualization of the mucosal surface and vascular pattern network. Endoscopic resection (ESD) was performed for the lesions.

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Long segment Barrett’s esophagus imaged with LCI.

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Small early gastric cancer visualized with LCI. The so called “red-in-purple” sign is always suspicious for neoplasia.

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Inflammatory colon polyps are common. As identification of dysplasia in those lesions is difficult, endoscopic resection should be performed.

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BLI highlights the mucosal surface and vascular pattern morphology. In combination with an optical zoom of 135-fold, optical diagnosis of a tubular adenoma can be easily achieved.

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Endoscopic full thickness resection with the FTRD system. Duplication of the single layers is clearly visible.

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Barrett’s cancer imaged with Linked Color Imaging (LCI) which strongly highlights the neoplastic tissue.

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Large duodenal lipoma

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Submucosal bulge in the esophagus, collapsing (right) suggesting esophageal duclication. Confirmation by endosonography showing mucosal structure in the wall of the duplication (below).

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Duodenum in Graft versus Host Disease (GvHD)

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Food residues in a smaller Zenker diverticulum

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Duodenal varices

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Recurrent Zenker diverticulum, scarring and deviating

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Healed duodenal ulcer without fibrin

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Small Zenker diverticulum (1 cm on barium swallow), hardly visible on endoscopy beside a hypertrophic upper sphincter

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Healing duodenal ulcer with elevated margin at the upper duodenal curve

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Linitis plastica (diffusely infltrating gastric cancer)

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Duodenal bulb ulcer

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Epiphrenic diverticulum in the distal esophagus

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Early gastric cancer at the angular fold (incisura angularis)

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Patient with a known ulcerative colitis and elevated liver enzyms - ERCP with typical aspect of a PSC

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Barrett esophagus after forceps biopsies, simulating erosions or neoplasia

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Patient with a large common bile duct stone

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Duodenal diverticulum

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Flat erosive Barrett cancer (AEG cancer type I, AEG=adenocarcinoma of esophagogastric junction)

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Classic long-segment Barrett esophagus

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Capsule endoscopy in a patient with "Blue rubber bleb naevus Syndrom", showing a venous ectasia in the jejunum

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Two angiodysplastic lesions at the gastric incisura (angular fold)

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Patient with a pseudomembranous colitis (Clostridium difficile)

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Barrett esophagus with prominent vessels in a patient with portal hypertension

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Multifocal areas of intestinal metaplasia (NBI imaging)

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Small flat duodenal adenoma in the descending duodenum

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Patient with Crohn's disease and fistulation from sigmoid colon to descending colon

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Known Barrett esophagus with 2 small neoplastic lesions, on histology metastases of breast cancer

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Fibrinous gastric erosions (NSAID)

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Flat duodenal adenoma at the distal end of the bulb

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Barrett mucosa in near focus and with acetic acid staining with central high-grade dysplastic lesion

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Pedunculated ampullary adenoma

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Polypoid gastric erosions

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Esophagus in advanced achalasia showing chronically inflamed and thickened mucosa and a distal ulcer due to pressure necrosis by obstructing food

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Hämorrhagic gastric erosions

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Duodenal involvement in Crohn´s disease

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Esophagus in achalasia showing muscular rings and prominent veins

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Perforation after endoscopic sphincterotomy

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Gastric erosion with biopsy positive for cancer, but ESD specimen negative („biopsy cancer“)

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Duodenal bulb with gastric metaplasia (magnification endoscopy)

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Distal esophagus in achalasia; muscular spasm leads to overvisualization of submucosal vessels

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Swollen und reddened papille with massive pus evaculation

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Atrophic gastritis in the gastric fundus with vascular pattern

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Duodenal bulb with reddisch gastric metaplasia

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Boerhave syndrome with deep defect.

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Papilla in a patient with Billroth II anatomy and pus

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Atrophic gastritis with small neuroendocrine tumor

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Duodenal mucosa with 3 small metastases of breats cancer (histologically confirmed)