Primary Intestinal Follicular Lymphoma Diagnosed by Double Balloon Endoscopy: Endoscopic Features and Treatment Outcomes

Objective: Little is known about the endoscopic features and clinical significance of small bowel (SB) lesions in primary intestinal follicular lymphoma (IFL). This study aimed to describe, based on a case series, detailed endoscopic features of SB lesions in IFLs and the relationship between clinical and histological stages. Methods: This retrospective study included 14 patients (8 females, median age, 61.5 years) newly diagnosed with IFL of SB. All patients underwent double balloon endoscopy (DBE), with both anterograde and retrograde approaches.Results: The distribution of IFLs in the GI tract were stomach 7%(1/14), duodenal bulb 7% (1/14), second part of the duodenum 93% (13/14), third part of the duodenum 86% (12/14), jejunum 93% (13/14), and ileum 43% (6/14). No colorectal lesions were detected. Multiple granules were the most frequently detected lesion, and were found in all patients. Nodule/mass lesions were detected in 5 patients. Nodule/mass lesions and ileal lesions were highly associated with the Lugano international classification. Eleven of 14 patients received chemotherapy plus Rituximab. Ten of 11 patients achieved complete response (CR). One patient achieved partial response (PR), but later exhibited disease progression. Four patients experienced grade 3 or 4 neutropenia, but all recovered without permanent side effects. One patient that achieved CR exhibited progressive disease after 54 months. All patients survived for a median of 35 months.Conclusions: DBE was necessary for the precise diagnosis of IFL involving the SB. Endoscopic features included a nodule/mass and ileal lesions, which were related to the clinical stage

Post-polypectomy surveillance: the present and the future

An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted

Unilateral multiple metallic stent-in-stent for a case of hilar biliary cancer: An alternative stenting strategy

The stenting strategy has been discussed in cases with unresectable hilar bile duct cancer (HBDC). We describe here a case of HBDC, 4 cm in size, invading the right portal vein and hepatic artery, which was only treated with repeated metallic stent placement, and the patient survived for a long period (51 months). Against Bismuth type-IV hilar biliary stricture, our strategy was to maintain the drainage of the largest, viable hepatic area (>50% of total liver) by unilateral multiple stent-in-stent