Papers by Mitchell Cappell
American Journal of Gastroenterology
ACG Case Reports Journal
A 65-year-old woman, status-post cholecystectomy and Roux-en-Y hepaticojejunostomy (circumstances... more A 65-year-old woman, status-post cholecystectomy and Roux-en-Y hepaticojejunostomy (circumstances unknown, 2017), was admitted (2020) for right upper quadrant abdominal pain and pyrexia for 3 days. Physical examination revealed a temperature of 39.1°C; no jaundice; soft, nondistended abdomen; and right upper quadrant tenderness. Alkaline phosphatase was 171 U/L, aspartate aminotransferase was 123 U/L, alanine aminotransferase was 100 U/L, and total bilirubin was 1.1 mg/dL. Leukocyte count was 10.4 bil/L, and leukocyte differential revealed neutrophilia (7.6 bil/L). Hematocrit and lipase were within normal limits.
Digestive Diseases and Sciences, 2017
Background Esophageal granular cell tumor (eGCT) is a rare, usually benign, neoplasm of neuroecto... more Background Esophageal granular cell tumor (eGCT) is a rare, usually benign, neoplasm of neuroectodermic origin. Eosinophilic esophagitis (EoE) is a relatively uncommon, immune-mediated, chronic disease. Both diseases commonly present with dysphagia. One case has been reported of simultaneous occurrence of both diseases. Aims To determine the association between diseases. Methods The present study was an IRB-approved, retrospective review of esophagogastroduodenoscopies (EGDs) with esophageal biopsies from two large hospitals, 1999-2014. Results Among 29,235 EGDs with esophageal biopsies for 16 years (167,434 total EGDs), 16 patients had pathologically diagnosed eGCT, and 1225 patients had pathologically diagnosed EoE. Five (31%) of 16 patients with eGCT had concomitant EoE (p = 0.001, OR 10.43, 95% ORCI 3.16-32.44, Fisher's exact test). Patients with simultaneous eGCT and EoE were young (mean age = 33.6 ± 12.9 years). Three were female. Dysphagia was presenting symptom in 4 (80%) of patients. Three had asthma. All five patients had [ 20 eosinophils/hpf in esophageal biopsy specimens. Three patients had endoscopic esophageal abnormalities suggesting EoE. Four patients were treated with a PPI (before and after diagnosis of EoE), and 2 patients underwent six-food-elimination diet with partial symptomatic improvement. The eGCTs averaged 13.4 ± 4.2 mm in maximal diameter and were located in upper-2, middle-2, and lower esophagus-2 (1 patient had 2 eGCTs). eGCTs were endoscopically resected-3 patients, and monitored-2 patients. Surveillance endoscopies revealed no recurrence or growth of eGCTs after resection (mean follow-up = 4.6 years). Conclusions This novel report of 5 patients with simultaneous EoE and eGCT adds to one, previously published case and suggests these two diseases are associated, and have a common pathophysiologic link, despite apparently different pathogenesis. Large, prospective, endoscopic and pathologic studies are warranted to further investigate this association. Keywords Granular cell tumor Á Eosinophilic esophagitis Á Eosinophils Á Esophagus Á Dysphagia Á Esophagogastroduodenoscopy (EGD) Á Esophageal motility disorders Borko Nojkov and Mitchell S. Cappell are equal primary authors.
Journal of Clinical Gastroenterology, 1991
Although typically small and submucosal, esophageal granular cell tumors frequently produce dysph... more Although typically small and submucosal, esophageal granular cell tumors frequently produce dysphagia. Esophageal manometry and a cine-esophagram in a patient with a 7-mm-wide esophageal granular cell tumor and dysphagia showed esophageal aperistalsis and a hypertensive lower esophageal sphincter that relaxed normally with swallowing. This finding suggests that dysmotility may contribute to the dysphagia frequently attributed to this tumor. This tumor is commonly believed to originate from Schwann cells and has a propensity to encompass and disrupt nerves that could produce the abnormal motility. Esophageal manometry is recommended when a small nonobstructing granular cell tumor is found in the evaluation of dysphagia.
Case Reports in Gastrointestinal Medicine, 2022
Immunocompromised patients with acquired immunodeficiency syndrome (AIDS) can develop opportunist... more Immunocompromised patients with acquired immunodeficiency syndrome (AIDS) can develop opportunistic esophageal candidial and cytomegaloviral infections. A case is reported which extends the clinico-endoscopic severity of these infections. A 32-year-old bisexual man with AIDS since 1997, and intermittently compliant with antiretroviral therapy, presented (2007) with dysphagia and 32 kg-weight loss. EGD revealed a massive, cheesy, esophageal mucosal exudate from Candida albicans. Cytomegalovirus was isolated by viral culture. The patient improved after fluconazole/ganciclovir therapy. The patient re-presented (2019) with hematemesis and dysphagia. EGD revealed cheesy esophageal exudate and profound “punched out” esophageal ulcers mimicking pseudo-diverticula. Histopathology confirmed candidiasis. Viral cultures revealed cytomegalovirus. Barium esophagram revealed deep esophageal ulcers/pseudo-diverticula. Repeat EGD 8 weeks later after ganciclovir/micafungin therapy revealed mostly he...
American Journal of Gastroenterology, 2021
Digestive Diseases and Sciences, 2021
Collagenous colitis (CC) is associated with non-bloody, watery diarrhea, which is pathophysiologi... more Collagenous colitis (CC) is associated with non-bloody, watery diarrhea, which is pathophysiologically reasonable because normal colonic absorption (or excretion) of water and electrolytes can be blocked by the abnormally thick collagen layer in CC. However, CC has also been associated with six previous cases of protein-losing enteropathy (PLE), with no pathophysiologic explanation. The colon does not normally absorb (or excrete) amino acids/proteins, which is primarily the function of the small bowel. Collagenous duodenitis (CD) has not been associated with PLE. This work reports a novel case of CD (and CC) associated with PLE; a pathophysiologically reasonable mechanism for CD causing PLE (by the thick collagen layer of CD blocking normal intestinal amino acid absorption); and a novel association of PLE with severe COVID-19 infection (attributed to relative immunosuppression from hypoproteinemia, hypoalbuminemia, hypogammaglobulinemia, and malnutrition from PLE).
Angiology, 1992
The authors present the case of an elderly patient suffering from obstructive cardiomyopathy and ... more The authors present the case of an elderly patient suffering from obstructive cardiomyopathy and bleeding colonic angiodysplasia. After treatment with propranolol, the bleeding stopped without recurrence.
Digestive Diseases and Sciences, 2021
Collagenous colitis (CC) is associated with non-bloody, watery diarrhea, which is pathophysiologi... more Collagenous colitis (CC) is associated with non-bloody, watery diarrhea, which is pathophysiologically reasonable because normal colonic absorption (or excretion) of water and electrolytes can be blocked by the abnormally thick collagen layer in CC. However, CC has also been associated with six previous cases of protein-losing enteropathy (PLE), with no pathophysiologic explanation. The colon does not normally absorb (or excrete) amino acids/proteins, which is primarily the function of the small bowel. Collagenous duodenitis (CD) has not been associated with PLE. This work reports a novel case of CD (and CC) associated with PLE; a pathophysiologically reasonable mechanism for CD causing PLE (by the thick collagen layer of CD blocking normal intestinal amino acid absorption); and a novel association of PLE with severe COVID-19 infection (attributed to relative immunosuppression from hypoproteinemia, hypoalbuminemia, hypogammaglobulinemia, and malnutrition from PLE).
Digestive Diseases and Sciences, 2016
The American Journal of Gastroenterology, 2009
The Israel Medical Association journal : IMAJ, 2008
It is common knowledge that in addition to the slaughter of millions of innocent civilians, Nazis... more It is common knowledge that in addition to the slaughter of millions of innocent civilians, Nazism caused direct damage to patient care by euthanasia of the handicapped, gruesome human experimentation, and ethnic cleansing of German medical schools. In gastroenterology, 53 prominent academicians living in Nazi-occupied Europe were persecuted by the Nazis. Prior studies analyzed this persecution as it related to gastroenterologists rather than to patient care. This study reports, however, that Nazi persecution led to a delay of more than one generation in the clinical application of major inventions by these gastroenterologists. These included flexible fiberoptic endoscopy, which was delayed from 1930 to 1957. Fiberoptic transmission was invented by Heinrich Lamm in 1930. Lamm was exiled from Nazi Germany in 1936, and this technique was clinically applied to endoscopy by Hirschowitz only in 1957. Another innovation was fecal occult blood testing for early colon cancer detection, whic...
Medicine, 2017
A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertens... more A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertension, caused by a left gastric artery (LGA) pseudoaneurysm (PA) compressing the splenic vein (SV) that was successfully treated with PA embolization. A 41-year-old man with previous medical history of recurrent, alcoholic pancreatitis presented with several episodes of hematemesis and abdominal pain for 48 hours. Physical examination revealed a soft abdomen, with no abdominal bruit, no pulsatile abdominal mass, and no stigmata of chronic liver disease. The hemoglobin declined acutely from 12.3 to 9.3 g/dL. Biochemical parameters of liver function and routine coagulation profile were entirely within normal limits. Abdominal CT revealed a 5-cm-wide peripancreatic mass compressing the stomach and constricting the SV. Esophagogastroduodenoscopy showed blood oozing from portal hypertensive gastropathy, small nonbleeding gastric cardial and fundal varices, gastric compression from the extrinsic...
New England Journal of Medicine, 2013
Digestive Diseases and Sciences, 2021
To the Editor To reduce exposure to COVID-19 infection during the current epidemic, we are now re... more To the Editor To reduce exposure to COVID-19 infection during the current epidemic, we are now replacing the live, onsite, interview process for first-year GI (gastroenterology) fellowship applicants, August–November 2020, at William Beaumont Hospital, Royal Oak, with virtual visits and interviews. The traditional site visit includes, aside from applicant interviews, guided hospital tours, a live presentation of the fellowship program, and confidential conversations between interviewees and current GI fellows. This work proposes the novel recommendation to replace all these traditional live interview visit events with virtual events to enhance the virtual visit experience. This institution is a large, tertiary, academic hospital with a GI fellowship continuously accredited since 1973 by the American College of Graduate Medicine Education, without current program citations, housed in a large academic GI division (36 GI attendings), with a very busy GI endoscopy suite (25,000 endoscop...
Digestive Diseases and Sciences
Dear Editor I congratulate Dr. Martin for his editorial published in the November 2020 issue of t... more Dear Editor I congratulate Dr. Martin for his editorial published in the November 2020 issue of the Journal [1], that proposes the immediate institution of non-emergent weekend endoscopic retrograde cholangiopancreatography (ERCP) in order to reduce hospital costs. These savings would be realized by decreasing hospital length-of-stay (LOS), increasing profits that could be reinvested in patient care. His editorial refers to our work appearing in the same issue of Digestive Diseases and Sciences [2], a retrospective multicenter, multiyear, comparative study of 533 analyzed ERCPs, that showed that non-emergent ERCPs performed on weekends, as compared with delaying ERCPs to the following weekdays, significantly reduced hospital costs without negatively impacting patient outcomes. This setup would require creating a specialized team on weekends for non-emergency ERCPs, composed of ERCP-certified gastroenterologists, nurse-anesthetists, supervising anesthesiologists, specialized ERCP nurses, specialized ERCP technicians, and perhaps radiology technicians. Patients would benefit from non-emergent ERCPs on weekends by decreased LOS by eliminating postponed ERCPs. Dr. Martin rightfully argues that cost savings by hospitals and insurance-payers created by this strategy should be shared with the ERCP weekend team members to compensate them for giving extra time away from home on weekends for non-emergencies, and be shared with the involved cost centers (e.g., endoscopy suite) to compensate for extra weekend expenses.
It is remarkable and a credit to our profession that so many medical scientists and biologists ar... more It is remarkable and a credit to our profession that so many medical scientists and biologists are willing to critically review manuscripts. The Editorial Board recognizes the time, energy, and expertise this requires. In an era of public relations and noncritical publication of medical and biologic scientific information, the role of Digestive Diseases and Sciences as a peer review free-standing journal is more important than ever. We depend on the individuals listed below for our ability to publish important readable and reliable papers.
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Papers by Mitchell Cappell