Practical Gastroenterology and Hepatology Board Review Toolkit

Nicholas J. Talley , Kenneth R. Devault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor


23.7 Endoscopic ultrasound examination of a submucosal lesion in the antrum

An esophagogastroduodenoscopy (EGD) performed on a patient with Type III paraesophageal hernia. Upon insertion of the endoscope, a mildly dilated esophagus is visualized. The endoscopist had difficulty passing the scope through the gastroesophageal junction. This was likely due to the volvulized stomach causing a mechanical obstruction at the gastroesophageal junction. As air was insufflated, the hernia was partially reduced and the stomach was partially detorsed. This enabled passage of the endoscope into the fundus and body. On retroflexion, a Type III hiatal hernia is noted with a large diaphragmatic defect. Although scope trauma is present, there is no evidence of mucosal ischemia or perforation.