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Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids

World Journal of Gastroenterology 2017年第27期23卷 5034-5040页

作者： Kenichi Yoshikawa Reimi Kawashima Yuki Hirose Keiko Shibata Takafumi Akasu Noriko Hagiwara Takeharu Yokota Nami Imai akira iwaku Go Kobayashi Hirohiko Kobayashi Akiyoshi Kinoshita Nao Fushiya Hiroyuki Kijima Kazuhiko Koike Masayuki Saruta Division of Gastroenterology and Hepatology Internal Medicinethe Jikei University Daisan Hospital Division of Gastroenterology and Hepatology Internal Medicinethe Jikei University School of Medicine

We are reporting a rare case of acute liver injury that developed after an internal hemorrhoid treatment with the aluminum potassium sulfate and tannic acid(ALTA) regimen. A 41-year-old man developed a fever and liver injury after undergoing internal hemorrhoid treatment with a submucosal injection of ALTA with lidocaine. The acute liver injury was classified clinically as hepatocellular and pathologically as cholestastic. We could not classify the mechanism of injury. High eosinophil and immunoglobulin E levels characterized the injury,and a drug lymphocyte stimulation test was negative on postoperative day 25. Fluid replacement for two weeks after hospitalization improved the liver injury. ALTA therapy involves injecting chemicals into the submucosa,from the rectum to the anus,and this is the first description of a case that developed a severe liver disorder after this treatment; hence,an analysis of future cases as they accumulate is desirable.

关键词： Aluminum potassium sulfate and tannic acid injection Aluminum potassium sulfate and tannic acid therapy Rectal submucosal injection Drug-induced lymphocyte stimulation test Drug-induced liver injury

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Endoscopic submucosal dissection in a patient with esophageal adenoid cystic carcinoma

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World Journal of Gastroenterology 2017年第45期23卷 8097-8103页

作者： Kenichi Yoshikawa Akiyoshi Kinoshita Yuki Hirose Keiko Shibata Takafumi Akasu Noriko Hagiwara Takeharu Yokota Nami Imai akira iwaku Go Kobayashi Hirohiko Kobayashi Nao Fushiya Hiroyuki Kijima Kazuhiko Koike Haruka Kaneyama Keiichi Ikeda Masayuki Saruta Division of Gastroenterology and Hepatology Internal MedicineJikei University Daisan Hospital Department of Endoscopy Jikei University Daisan Hospital Division of Gastroenterology and Hepatology Internal MedicineJikei University School of Medicine

We report the first use of endoscopic submucosal dissection(ESD) for the treatment of a patient with adenoid cystic carcinoma of the esophagus(EACC). An 82-year-old woman visited our hospital for evaluation of an esophageal submucosal tumor. Endoscopic examination showed a submucosal tumor in the middle third of the esophagus. The lesion partially stained with Lugol's solution,and narrow band imaging with magnification showed intrapapillary capillary loops with mild dilatation and a divergence of caliber in the center of the lesion. Endoscopic ultrasound imaging revealed a solid 8 mm × 4.2 mm tumor,primarily involving the second and third layers of the esophagus. A preoperative biopsy was non-diagnostic. ESD was performed to resect the lesion,an 8 mm submucosal tumor. Immunohistologically,tumor cells differentiating into ductal epithelium and myoepithelium were observed,and the tissue type was adenoid cystic carcinoma. There was no evidence of esophageal wall,vertical stump or horizontal margin invasion with p T1 b-SM2 staining(1800 μm from the muscularis mucosa). Further studies are needed to assess the use of ESD for the treatment of patients with EACC.

关键词： Adenoid cystic carcinoma of esophagus Endoscope Ultrasound Esophageal Tumor Endoscopic submucosal dissection

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