By Dr. Olga Lobanova from Oncology department.

1. Ulcers of the Stomach
Image 1
Double Pylorus With Ulcers
This image shows what can happen when an ulcer injures the stomach. On the left is the normal
pylorus which is the channel through which food and liquid exit the stomach into the duodenum, the
first portion of the small bowel. On the right is a second exit which has been caused by a previous
ulcer which burst through into the duodenum. If it had perforated into the abdomen, it would have
caused acute peritonitis, a surgical emergency. You can see that the ulcer disease is still active with
a new white-based ulcer in the distance. The previous and present ulcers were caused by the
stomach bacteria infection called Helicobacter pylori. Antibiotics cleared the infection and cured her
ulcer problem.
Malignant Tumors of the Stomach
Image 1
Gastric Lymphoma
A lymphoma is a malignant tumor that arises from the lymphoid cells in the body. They can occur
almost anywhere in the body, including the stomach. In this instance, the tumor is present in the
upper portion of the stomach and appears as an irregular ball. The black endoscope can be seen
beside it. The endoscope has been bent into a U-turn so that the tumor can be seen. These tumors
usually require surgery and the outcome is often good.

2. Gastroesophageal Reflux Disease (GERD)
Image 1 Image 2
Image 3 Image 4
Examples of GERD
When acid from the stomach bathes the lower esophagus, a feeling of heartburn occurs. In some
people, actual tissue damage occurs. This can cause some mild inflammation or reddening of the
lower esophagus as seen in Image 1 or a slight erosion which has a whitish center surrounded by
inflamed red tissue seen in Image 2. In the severe cases, extensive deep ulcerations occur. Images 3
and 4 show these ulcers.
Benign Tumors of the Esophagus
Image 1
Esophageal Polyp
A polyp is a growth. Most polyps are benign but certain types can become malignant. They can
occur anywhere in the intestinal tract, especially the colon. Infrequently, they develop in the
esophagus. They are rather easy to remove through the endoscope. This 1 inch polyp in the lower
esophagus was an incidental finding. The whitish material is coagulated saliva. On pathology exam,
it was a benign adenoma type polyp.

3. Duodenal Ulcer
Image 1 Image 2
Image 3
Examples of Duodenal Ulcer
Ulcers often occur within the duodenum, usually in the first part just beyond the stomach which is
called the duodenal cap. Ulcers can come in all shapes and sizes. Image 1 shows a single white-
based ulcer. Image 2 shows numerous small ulcers scattered across the duodenal cap. Image 3
demonstrates a huge duodenal ulcer almost filling the cap. Note the brownish areas across the
whitish base which is caused by some old blood. Some fresh bleeding is seen at the edge. Duodenal
ulcers are caused by the bacteria, Helicobacter pylori, or by arthritis medications such as Advil,
Motrin, Naprosyn, aspirin and many others. All of these ulcers healed under appropriate therapy.

4. Duodenal Tumors
Image 1
Lymphoid Polyposis
This is a benign but peculiar looking condition. The intestine is packed with lymphoid tissue which
is necessary as part of the body's immune system which protects us from infection. Most of the
intestinal lymph deposits are below the surface and not usually seen. In this instance, the duodenum
is full of these benign lymph nodules. They cause no problem and do not need treated. They are just
an endoscopic oddity
Malignant Tumors
Image 1 Image 2
Image 3 Image 4
Colon Cancer
Most cancers in the colon originate in adenoma type polyps. These adenomas start out being benign.
Then, as they get larger, they can become cancerous. That is why polyps are always removed from
the colon when they are found. Cancers come in all sizes. Image 1 shows a small cancerous polyp
about the size of an olive. The chance for a complete cure in this case is probably very good. Image
2 shows the same site after the polyp has been removed with cautery. The base of the polyp looks

5. nice and clean. Images 3 and 4 show more advanced cancers in the rectum and cecum or right colon
respectively. At this point, surgery is needed to remove the diseased segment of colon.
Diverticular Disease
Image 1 Image 2
Diverticular Inflammatory Bowel Disease
This is an unusual condition. Please review the information on diverticulosis first, so you know what
diverticuli are. Inflammatory bowel disease is a chronic inflammation of the bowel lining. It may be
called either ulcerative colitis or Crohn's disease. A third type of inflammation can occur with severe
diverticulosis. The lining can become very reddened and then bleed. In these cases, the
inflammation remains localized in the area with diverticulosis and never extends further. Treatment
is usually the same as for ulcerative colitis or Crohn's disease. Here you see two images of the
sigmoid colon. Image 1 a shows small black opening of a diverticuli on the left. Above it is the
markedly reddened and inflamed fold. Image 2 shows scattered areas of inflammation.