Herpetic esophagitis: An uncommon cause of dysphagia

Herpes simplex esophagitis usually occurs in immune-compromised patients. We report a case of 44 year-old lady without any immune deficient state, who presented with dysphagia and retrosternal pain. Upper GI endoscopy revealed multiple punched out ulcers in esophagus. Biopsy from these ulcers revealed intranuclear eosinophilic inclusion bodies and multinucleated epithelial giant cells suggestive of herpetic esophagitis. Serum HSV-1 IgM antibodies was positive. Dysphagia improved on treatment with acyclovir

Pancreaticopleural fistula: Report of two cases and review of literature

Pancreaticopleural fistula is a rare clinical problem. It is seen rarely in acute and chronic pancreatitis or after pancreatic duct trauma. It poses a diagnostic challenge. It may be silent or can present with predominant chest or abdominal symptoms. The diagnosis should be suspected if a patient presents with pleural effusion in a setting of pancreatitis or alcohol intake. The significantly raised amylase in the pleural fluid offers an important clue to the diagnosis. Computed tomography is the initial imaging of choice, which defines the pancreatic as well as chest abnormalities. The therapeutic options include medical, endoscopic, as well as surgical interventions. Although, there is no data comparing the endoscopic and surgical interventions, patients are generally treated with medical and endoscopic therapies. Surgery is reserved for those who fail medical and endoscopic therapies. Here we report two cases of pancreaticopleural fistulas that were treated successfully by endoscopic retrograde cholangiopancreatography and placement of a plastic stent in the main pancreatic duct

A case of abdominal pain and abnormal location of gallstone diagnosed by endoscopic ultrasound

A 50‑year‑old male came to us with pain abdomen; endoscopic ultrasound (EUS) made a diagnosis of cholecystoduodenal fistula which was later on confirmed on gastroscopy and surgery. We present interesting images of EUS; a calculus is visualized outside gallbladder with inflammatory changes of duodenal wall

Endoscopic Ultrasound‑Guided Fine Needle Aspiration from Pericardial Lesion: A Case of Metastatic Pericardial Involvement from Breast Malignancy

Tissue acquisition from mediastinum is difficult due to anatomic location and presence of vessels. Endoscopic ultrasound provides access to difficult mediastinal locations that are near esophagus. We describe a case of pericardial lesion, endoscopic ultrasound guided guided fine needle aspiration cytology was done and the lesion proved to be metastatic in nature

A case series of gastric outlet obstruction secondary to tuberculosis: New diagnostic and treatment paradigm

Tuberculosis can involve any part of gastrointestinal tract. Gastro-duodenal involvement in tuberculosis is rare. We report four cases of gastric outlet obstruction due to tuberculosis. In all of these patients obstruction was due to extra-luminal compression from lymph-nodes. Clinical presentation was with epigastric pain and recurrent vomiting. Upper GI endoscopy revealed duodenal stricture without any active ulcer or mass. Computed tomography scan showed duodenal thickening along with abdominal lymph nodes. Diagnosis was confirmed with EUS guided FNAC. Antral dilatation using CRE can be used as first treatment option for obstruction in these patients. Patients non responsive to dilatation may require surgery

Esophageal squamous cell carcinoma presenting as submucosal lesion with repeatedly negative endoscopic biopsies

A 74-year-old male presented with dysphagia for 2 months. Computed tomography revealed irregular wall thickening of the esophagus at T3 to T5 level. He underwent gastroscopy which revealed a submucosal bulge with normal mucosa at 25 cm from incisors. Repeated biopsies were taken, all were negative for malignancy. The patient underwent endoscopic ultrasound, and fine-needle aspiration was taken which was suggestive for squamous cell carcinoma

Endoscopic ultrasound-guided fine-needle aspiration of an aortocaval lymph node by the transcaval approach

A 59-year-old male was diagnosed as carcinoma gallbladder around 1 year back and underwent radical cholecystectomy. He also received four cycles of chemotherapy. Now, he complained upper abdominal heaviness; positron emission tomography-computed tomography (PET-CT) was done which showed PET-avid 8.5 mm sized lymph node at aortocaval region. There was no safe route, so endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) was advised. However, FNA was not possible without crossing inferior vena cava and further management depended on FNA report. The EUS-FNA was done, and cytopathological smears were consistent with metastatic adenocarcinoma. There was no complication

Intraductal Ultrasonography in Pancreatobiliary Diseases

Intraductal ultrasonography (IDUS) utilizes probe catheter and operates at a higher frequency (12–30 MHz). It can be passed down the biopsy channel of a side‑view endoscope during endoscopic retrograde cholangiopancreatography, and it provides real‑time, high‑quality imaging of pancreatobiliary ducts and the surrounding structures. IDUS has been used in defining choledocholithiasis, evaluating biliary as well as pancreatic strictures or thickening, and local staging of tumor. We shall discuss the utility of IDUS in the current review