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"documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Gastroenterol Hepatol. 2024;47:384-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Endoscopic resection of a large symptomatic duodenal lipoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "384" "paginaFinal" => "386" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resección endoscópica de un gran lipoma duodenal sintomático" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 558 "Ancho" => 987 "Tamanyo" => 99752 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large duodenal lipoma arising in the D2 duodenum.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luka Strnisa, Samo Plut, Sasa Golob, Aleksandar Gavric" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Luka" "apellidos" => "Strnisa" ] 1 => array:2 [ "nombre" => "Samo" "apellidos" => "Plut" ] 2 => array:2 [ "nombre" => "Sasa" "apellidos" => "Golob" ] 3 => array:2 [ "nombre" => "Aleksandar" "apellidos" => "Gavric" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424001871?idApp=UINPBA00004N" "url" => "/24443824/0000004700000004/v1_202405220556/S2444382424001871/v1_202405220556/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "What shall we do with yellowish rectal lesions during screening colonoscopy?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "387" "paginaFinal" => "388" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Vincent Zimmer" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Vincent" "apellidos" => "Zimmer" "email" => array:1 [ 0 => "vincent.zimmer@gmx.de" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Qué haremos con las lesiones rectales amarillentas durante colonoscopia de detección?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1531 "Ancho" => 2007 "Tamanyo" => 422992 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Colonoscopy identified an estimated 5-mm yellowish subepithelial lesion in the rectum at 5<span class="elsevierStyleHsp" style=""></span>cm from the anal verge. (B) After forceps palpation demonstrating a firm consistence (<a class="elsevierStyleCrossRef" href="#sec0015">Suppl. Video</a>), the patient underwent primary ligation-assisted endoscopic resection, confirming a well-differentiated neuroendocrine neoplasia (NEN – G1, Ki-67<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1%, R0). (C) In another patient, colonoscopy showed another 5-mm yellowish subepithelial lesion at 3<span class="elsevierStyleHsp" style=""></span>cm from the anal verge with a typical “<span class="elsevierStyleItalic">pillow</span>” sign (<a class="elsevierStyleCrossRef" href="#sec0015">Suppl. Figure</a>). (D) Lipoma diagnosis was further substantiated by demonstrating a “<span class="elsevierStyleItalic">naked fat</span>” sign after forceps biopsy of overlying mucosa.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Small yellowish rectal lesions are commonly observed during office-based screening colonoscopy, and the differential diagnosis includes neuroendocrine neoplasia (NEN, to be appropriately resected) and lipoma (to be left). While optical assessment oftentimes suggests the proper diagnosis, an additional forceps palpation may prove informative and guide the endoscopy strategy. This is exemplified in the following back-to-back case vignettes. In patient 1, an estimated 4-mm yellowish lesion emerged in the rectum at 5<span class="elsevierStyleHsp" style=""></span>cm from the anal verge (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 1</a>A). Palpation with a forceps indicated a firm consistence (<a class="elsevierStyleCrossRef" href="#sec0015">Suppl. Video</a>), supporting a diagnosis of NEN. Therefore, we opted for primary ligation-assisted resection biopsy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 1</a>B), confirming a well-differentiated NEN (3<span class="elsevierStyleHsp" style=""></span>mm, G1, Ki-67<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1%, R0). In patient 2, another 5-mm lesion was detected at 3<span class="elsevierStyleHsp" style=""></span>cm from the anal verge (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 1</a>C) with a typical <span class="elsevierStyleItalic">pillow</span> sign (<a class="elsevierStyleCrossRef" href="#sec0015">Suppl. Figure</a>). An unequivocal lipoma diagnosis was established by the “<span class="elsevierStyleItalic">naked fat</span>” sign provoked by forceps biopsy of overlying mucosa (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 1</a>D).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In particular, rectal NENs are increasingly being diagnosed during routine colonoscopy with primary recognition ideally resulting in referral for work-up in larger lesions. By contrast, in small lesions <9<span class="elsevierStyleHsp" style=""></span>mm without mandatory need for systematic staging examinations, primary <span class="elsevierStyleItalic">ad hoc</span> resection, <span class="elsevierStyleItalic">e.g.</span> by the ligation-assisted technique, may streamline endoscopic management in experienced hands, considering that attempts at forceps removal and/or standard polypectomy typically results in incomplete resections.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">Nothing to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "Reference" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0025" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1531 "Ancho" => 2007 "Tamanyo" => 422992 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Colonoscopy identified an estimated 5-mm yellowish subepithelial lesion in the rectum at 5<span class="elsevierStyleHsp" style=""></span>cm from the anal verge. (B) After forceps palpation demonstrating a firm consistence (<a class="elsevierStyleCrossRef" href="#sec0015">Suppl. Video</a>), the patient underwent primary ligation-assisted endoscopic resection, confirming a well-differentiated neuroendocrine neoplasia (NEN – G1, Ki-67<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1%, R0). (C) In another patient, colonoscopy showed another 5-mm yellowish subepithelial lesion at 3<span class="elsevierStyleHsp" style=""></span>cm from the anal verge with a typical “<span class="elsevierStyleItalic">pillow</span>” sign (<a class="elsevierStyleCrossRef" href="#sec0015">Suppl. Figure</a>). (D) Lipoma diagnosis was further substantiated by demonstrating a “<span class="elsevierStyleItalic">naked fat</span>” sign after forceps biopsy of overlying mucosa.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 4435808 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 2 => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "mmc1.jpeg" "Alto" => 564 "Ancho" => 750 "Tamanyo" => 49377 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ENETS consensus guidelines update for colorectal neuroendocrine neoplasms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.K. Ramage" 1 => "W.W. De Herder" 2 => "G. Delle Fave" 3 => "P. Ferolla" 4 => "D. Ferone" 5 => "T. Ito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000443166" "Revista" => array:6 [ "tituloSerie" => "Neuroendocrinology" "fecha" => "2016" "volumen" => "103" "paginaInicial" => "139" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26730835" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004700000004/v1_202405220556/S2444382424001883/v1_202405220556/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004700000004/v1_202405220556/S2444382424001883/v1_202405220556/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424001883?idApp=UINPBA00004N" ]
Journal Information
Vol. 47. Issue 4.
Pages 387-388 (April 2024)
Vol. 47. Issue 4.
Pages 387-388 (April 2024)
Image of the month
What shall we do with yellowish rectal lesions during screening colonoscopy?
¿Qué haremos con las lesiones rectales amarillentas durante colonoscopia de detección?
Article information
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