Houssem Ammar

By Rahul Gupta, Nalini Bansal, Houssem Ammar and Jyoti Gupta

Malignant melanoma is an aggressive disease. The anorectal region is the most common site of primary gastrointestinal malignant melanoma. Due to its low incidence, the diagnosis is often delayed. The most characteristic clinical feature of this tumor is its brown-black appearance due to the melanin pigment. However, the pigmentation may be absent in up to 20% cases. Timely diagnosis and treatment are crucial for achieving good long-term outcomes. Surgical excision remains the treatment of choice for localized disease. However, the extent of surgery has been a matter of debate. Anorectal melanoma is a highly malignant disease, and more than 50% cases have metastasis at the time of diagnosis. Targeted therapies especially immune check point inhibitors have brought about a paradigm shift in the management of cutaneous melanoma. They are being increasingly used for mucosal melanomas, and their role in anorectal melanoma is being investigated in various clinical trials.

Part of the book: Melanoma

By Rahul Gupta, Arvind K. Singh, Jyoti Gupta and Houssem Ammar

With the advances in the endoscopic technology, most of the small bowel diseases are being diagnosed by capsule endoscopy and device assisted enteroscopy. However, there are many clinical situations such as small bowel obstruction, foreign body impaction were these advanced endoscopic procedures cannot be performed. In such cases, intraoperative endoscopy plays a vital role in the management of these small bowel diseases. Intraoperative endoscopy is also very useful in identification of the site of obscure gastrointestinal bleeding in difficult cases. Moreover, capsule endoscopy and device assisted enteroscopy are expensive procedures and not readily available at all medical centers especially in low income countries. On the other hand, intraoperative endoscopy can be easily performed by conventional gastroscope and colonoscope. In this chapter, we have discussed the indications, techniques, outcomes and complications of intraoperative endoscopy in the current era of deep enteroscopy.

Part of the book: Endoscopy in Small Bowel Diseases