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teroscopy (DBE) into clinical practice has enabled us to examine lesions, even those located in the jejunum [1]. DBE has also been reported to be useful for the treat− ment of bleeding jejunal lesions [2]. We report a case of gastrointestinal stromal tumor (GIST) of the jejunum, a precise preoperative diagnosis of which was made with DBE. A 48−year−old man was referred for evalu− ation of repeated bloody stools. The Hb level was 5.4 mg/dL. Esophagogastroduo− denoscopy, colonoscopy, and push en− teroscopy (PCF P240 AI; Olympus, Tokyo, Japan) failed to reveal any obvious lesion. DBE (EN450 T5/20; Fujinon−Toshiba ES system, Tokyo, Japan) was carried out, and a submucosal lesion was noted in the jejunum, located approximately 1 m distal to the ligament of Treitz (l" Fig. 1). A small ulceration with active bleeding was noted at the top of the lesion. Hyper− tonic saline epinephrine injection was successfully carried out to terminate the bleeding. Endoscopic ultrasound with a 12−MHz US catheter probe (SP−702; Fuji− non−Toshiba) disclosed a dumbbell− shaped tumor in the jejunal wall (l" Fig. 2). It measured 2 cm in diameter, with a homogeneous, hypoechoic pat− tern. It was contiguous with the proper muscle layer (l" Fig. 3). A preoperative di− agnosis of jejunal GIST was made. The le− sion was resected surgically. The jejunal submucosal tumor was recog− nized from the outside of the lumen (l" Fig. 4). The macroscopic view of the formalin−fixed specimen revealed clearly the dumbbell shape of the tumor (l" Fig. 5); it measured 22  19 mm. Mi− croscopically, the lesion was composed of interlacing bundles of spindle cells with no atypia, which derived from the proper muscle layer. No mitosis was no− ted (0/50 high−power field). Immunohis− tochemical study revealed positive stain− ing of c−kit (l" Fig. 6) and CD34. MIB−1 labeling index was 2 %. Postoperative his− tologic diagnosis was jejunal GIST, classi− fied as low risk. DBE is a useful modality for both diagnos− tic and therapeutic purposes.

Endosonographic detection of dumbbell-shaped jejunal GIST using double balloon enteroscopy