to be asymptomatic. There was no recurrence of pseudo-cyst at 1-year follow-up.

DISCLOSURE

The authors have no disclosure.

Hiroshi Kakutani, PhD, MD, Hiroo Imazu, PhD, MD,Yujiro Uchiyama, MD, Tomoyoshi Okamoto, PhD, MD,Hisao Tajiri, PhD, MD, Jikei University School of Medicine,Tokyo, Japan

doi:10.1016/j.gie.2006.01.041

CommentaryTreatment of pancreatic duct–communicating pseudocysts by stenting is a well-recognized therapy, as is decompression ofa cyst into an adjoining organ such as the stomach. It is unusual, however, that the first procedure is followed by the other,especially as a spontaneous event. Fortunately, this is another example of how Mother Nature often does it well, if not better.A note of caution: injection of contrast material into a pseudocyst should prompt use of antibiotics and immediate drainage toprevent infection.

Lawrence J. Brandt, MDAssociate Editor for Focal Points

At the Focal Point

An unusual cause of biliary colic

276 GASTROINTESTINAL ENDOSCOPY Volume 64, No. 2 : 2006 www.giejournal.org

At the Focal Point

A 62-year-old woman with hepatitis C cirrhosis was seenfor severe right upper quadrant pain similar to prior epi-sodes of biliary colic. She had a complicated cholecystec-tomy in 1971 with biliary-enteric anastomosis and bloodtransfusion causing hepatitis C.

A feeding tube was recently placed at an outside hospital forsevere malnutrition before liver transplantation. After initia-tion of feeding, severe pain ensued. On examination, exquisiteright upper quadrant tenderness was appreciated. Admissionradiography revealed abnormal positioning of the tube in theright upper quadrant (A). Computed tomographic scan con-firmed placement of tube within the biliary-enteric anastomo-sis (B). Examination under fluoroscopy revealed side-to-sidecholedochoduodenostomy anatomy (C, black arrow) anddistal end of tube in the common bile duct. The tube was

Hookworm infestation diagnosed(with video)

www.giejournal.org

reduced under direct fluoroscopic guidance into the stomach(C, white arrow). The patient had immediate resolution ofpain. She then tolerated tube feeding well.

DISCLOSURE

The authors have nothing to disclose.

Jeremias C. Tan, MD, Fredric D. Gordon, MD, Departmentof Gastroenterology, Lahey Clinic Medical Center, Burlington,Massachusetts, USA

doi:10.1016/j.gie.2006.01.043

CommentaryBiliary-enteric anastomoses are best used as a conduit for bile to flow into the duodenum, not for duodenal contents or nu-trients to flow retrograde into the pancreaticobiliary system. Retrograde passage is seen with a closed duodenal loop and mayinclude foreign bodies such as enteroliths, ingested nematodes or trematodes, and now this interesting nutritional infusate.Whether the pain was true biliary colic, which is not colic at all, or if it resulted from stimulation of stretch and chemical re-ceptors in the biliary epithelium is not clear and with luck will not be seen more frequently than other medical anecdotes.

Lawrence J. Brandt, MDAssociate Editor for Focal Points

by capsule endoscopy

Volume 64, No. 2 : 2006 GASTROINTESTINAL ENDOSCOPY 277