http://daveproject.org/ The DAVE Project - Gastroenterology is a collection of teaching tools. The focus is gastrointestinal endoscopic video clips and presentations using the full spectrum endoscopic imaging supported by pathologic, radiologic, and surgical images. Physicians are able to submit, for consideration, new entries to enrich and expand the atlas. en-us dcollier@daveproject.org (Dan Collier) 60 Copyright held by original authors. Released under a Creative Commons license. Thu, 21 Jan 2010 03:01:33 EST http://daveproject.org/viewfilms.cfm?film_id=889 Mike Babineaux, MD,, University of Texas Medical Branch, Gabriel Lee, MD,, University of Texas Medical Branch, Andrew W. DuPont, M.D., Assistant Professor of Medicine, University of Texas Medical Branch http://daveproject.org/viewfilms.cfm?film_id=889 http://daveproject.org/media/images/clip_img/180x120/pjs-intussuception.jpg Mike Babineaux, MD,, University of Texas Medical Branch, Gabriel Lee, MD,, University of Texas Medical Branch, Andrew W. DuPont, M.D., Assistant Professor of Medicine, University of Texas Medical Branch Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Tue, 19 Jan 2010 04:01:09 EST http://daveproject.org/viewfilms.cfm?film_id=785 Rajesh N. Keswani, MD,, Washington University, Steven A. Edmundowicz, MD,, Washington University http://daveproject.org/viewfilms.cfm?film_id=785 http://daveproject.org/media/images/clip_img/180x120/jpeg.d.div.obs.cli.nif.1oo.ke0508us1.jpg Rajesh N. Keswani, MD,, Washington University, Steven A. Edmundowicz, MD,, Washington University Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Wed, 13 Jan 2010 06:01:52 EST http://daveproject.org/viewfilms.cfm?film_id=820 Jonathan M Buscaglia, MD, Instructor of Medicine, Johns Hopkins Medical Center http://daveproject.org/viewfilms.cfm?film_id=820 http://daveproject.org/media/images/clip_img/180x120/vlcsnap-14933305.jpg Jonathan M Buscaglia, MD, Instructor of Medicine, Johns Hopkins Medical Center Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Tue, 08 Dec 2009 05:12:08 EST http://daveproject.org/viewfilms.cfm?film_id=888 Kapil Gupta, M.D., Assistant Professor of Medicine, Hennepin County Medical Center, University of Minnesota http://daveproject.org/viewfilms.cfm?film_id=888 http://daveproject.org/media/images/clip_img/180x120/gupta078_AT_umn.edu-Looptip-1.jpg Kapil Gupta, M.D., Assistant Professor of Medicine, Hennepin County Medical Center, University of Minnesota Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Fri, 20 Nov 2009 11:11:33 EST http://daveproject.org/viewfilms.cfm?film_id=887 Manmeet Padda, MD, Advanced Endoscopy Fellow, Yale University, Uzma Siddiqui, M.D., Assistant Professor of Medicine, Yale University, Harry Aslanian, M.D., Associate Professor of Medicine, Yale University, Priya A. Jamidar, MD, Professor of Medicine, Director of Endoscopy, Yale University http://daveproject.org/viewfilms.cfm?film_id=887 http://daveproject.org/media/images/clip_img/180x120/evca.p.bal.dil.stn.pa0911-1.jpg Manmeet Padda, MD, Advanced Endoscopy Fellow, Yale University, Uzma Siddiqui, M.D., Assistant Professor of Medicine, Yale University, Harry Aslanian, M.D., Associate Professor of Medicine, Yale University, Priya A. Jamidar, MD, Professor of Medicine, Director of Endoscopy, Yale University Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Fri, 20 Nov 2009 10:11:39 EST http://daveproject.org/viewfilms.cfm?film_id=886 Alina Stoita, MBBS, Advanced Trainee in Gastroenterology, St Vincent's Hospital Sydney, Australia, David Williams, MBBS, Head of Department of Gastroenterology, St Vincent's Hospital Sydney, Australia http://daveproject.org/viewfilms.cfm?film_id=886 http://daveproject.org/media/images/clip_img/180x120/Fig 1 Lesion in the neck of the pancreas on CT.jpg Alina Stoita, MBBS, Advanced Trainee in Gastroenterology, St Vincent's Hospital Sydney, Australia, David Williams, MBBS, Head of Department of Gastroenterology, St Vincent's Hospital Sydney, Australia Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Fri, 20 Nov 2009 10:11:16 EST http://daveproject.org/viewfilms.cfm?film_id=885 Jonathan M Buscaglia, MD, Instructor of Medicine, Johns Hopkins Medical Center, Anthony Kalloo, M.D., Chief of Gastroenterology, Johns Hopkins Medical Center http://daveproject.org/viewfilms.cfm?film_id=885 http://daveproject.org/media/images/clip_img/180x120/evca.p.es.stent.bu0910.jpg Jonathan M Buscaglia, MD, Instructor of Medicine, Johns Hopkins Medical Center, Anthony Kalloo, M.D., Chief of Gastroenterology, Johns Hopkins Medical Center Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Mon, 09 Nov 2009 06:11:57 EST http://daveproject.org/viewfilms.cfm?film_id=884 Jonathan M Buscaglia, MD, Instructor of Medicine, Johns Hopkins Medical Center http://daveproject.org/viewfilms.cfm?film_id=884 http://daveproject.org/media/images/clip_img/180x120/EUS T3 image.BMP Jonathan M Buscaglia, MD, Instructor of Medicine, Johns Hopkins Medical Center Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Wed, 28 Oct 2009 05:10:48 EST http://daveproject.org/viewfilms.cfm?film_id=883 B. Joseph Elmunzer, MD,, University of Michigan, Amaar Ghazale, MD,, University of Michigan, Akbar K. Waljee, MD,, University of Michigan, Craig M. Womeldorph MD,, University of Michigan http://daveproject.org/viewfilms.cfm?film_id=883 http://daveproject.org/media/images/clip_img/180x120/thumbnail photo.BMP B. Joseph Elmunzer, MD,, University of Michigan, Amaar Ghazale, MD,, University of Michigan, Akbar K. Waljee, MD,, University of Michigan, Craig M. Womeldorph MD,, University of Michigan Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Wed, 28 Oct 2009 05:10:12 EST http://dave1.mgh.harvard.edu/viewfilms.cfm?film_id=715 Lauren Layer, Medical Student, University of Texas Medical Branch, Sathya Jaganmohan, MD, GI Fellow, University of Texas Medical Branch, Gottumukkala S. Raju, M.D., Director of Endoscopy, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch, Andrew W. DuPont, M.D., Assistant Professor of Medicine, University of Texas Medical Branch http://daveproject.org/viewfilms.cfm?film_id=715 http://daveproject.org/media/images/clip_img/180x120/uvs090308-0011.jpg Lauren Layer, Medical Student, University of Texas Medical Branch, Sathya Jaganmohan, MD, GI Fellow, University of Texas Medical Branch, Gottumukkala S. Raju, M.D., Director of Endoscopy, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch, Andrew W. DuPont, M.D., Assistant Professor of Medicine, University of Texas Medical Branch Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Wed, 21 Oct 2009 08:10:15 EST http://daveproject.org/viewfilms.cfm?film_id=882 Mohammad Bilal,, Harvard Medical School, David G. Forcione, M.D., Instructor in Medicine, Harvard Medical School, Massachusetts General Hospital, Peter B. Kelsey, M.D., Assistant Professor of Medicine, Harvard Medical School, Massachusetts General Hospital http://daveproject.org/viewfilms.cfm?film_id=882 http://daveproject.org/media/images/clip_img/180x120/jpeg.i.pig.ooo.ooo.bio.1oo.br060613.jpg Mohammad Bilal,, Harvard Medical School, David G. Forcione, M.D., Instructor in Medicine, Harvard Medical School, Massachusetts General Hospital, Peter B. Kelsey, M.D., Assistant Professor of Medicine, Harvard Medical School, Massachusetts General Hospital Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Mon, 19 Oct 2009 12:10:26 EST http://daveproject.org/viewfilms.cfm?film_id=881 Author: Mohamad A. Eloubeidi, M.D., M.H.S., F.A.C.P., F.A.C.G. FASGE Associate Professor of Medicine and Pathology Director, Endoscopic Ultrasound Program Co-Director Pancreatico-biliary Center Institution: University of Alabama at Birmingham Department of Medicine Division of Gastroenterology/Hepatology Statement of COI: Dr. Eloubeidi reports no conflicts of interests relating to this video presentation A 62 year old lady with pancreatic cancer was diagnosed two weeks ago at our center by EUS-guided FNA. We started her on Loretab but unfortunately it did not help her pain. During her last examination by EUS and by CT scan of the abdomen there is clear evidence of involvement of the celiac artery and therefore she is not amenable for surgical resection. We counseled her regarding the need for celiac plexus neurolysis (CPN) and she's here today to undergo CPN. Many studies published to date suggest that EUS-guided CPN is really helpful in the setting of pancreatic cancer pain and leads to success in about 70-80% of the patients. It is a safe procedure performed on outpatient basis under conscious sedation. We have given our patient a low dose of Demerol, and Verset, and we used low dose Ketamine as an adjunct to sedation. Typically we insert the echo endoscope to the level of the celiac artery where the injection is performed at its base. The echo endoscope is inserted in the patient esophagus. It was a smooth intubation. When the echoendoscope is at about 35 cm from the incisors we switch to ultrasound. The landmark we look for is really the descending aorta at about 35-40 centimeters from the incisors. The descending aorta is a tubular organ as you see here with color Doppler ultrasound. Once you identify the aorta you push forward with the echo endoscope until you find the first branching artery and that's the celiac artery. To confirm further it would be nice to demonstrate the superior mesenteric artery as you can see in this image back to back. This way you are sure you are performing the celiac neurolysis in the right area. Also for confirmatory purposes we perform color Doppler sonography to identify further the celiac artery and to be sure that there are no intervening vessels in the way. The arrow actually is a good location and estimation of where I need my needle to be to initiate the injection. I am currently using the CPN needle it's a 20 gauge needle. I think the advantages are clear with using it. In comparison to the 22 gauge needle I think we can do a quicker and faster injection. I think I crossed the wall of the stomach here and then we're going to aspirate to ensure we don't have any blood return. We are performing the injection, again it's all at the tip of the arrow- you see the needle in place. That actually created a nice cushion for us to inject the alcohol. Now here we better be sure of the needle placement since the alcohol will create a hyperechoic shadow that will block the view as you see in this image. As you see the injections really quick with this fenestrated needle we used 6ccs of bupivacaine and we injected 20 ccs of absolute alcohol in this area. We withdraw the needle from the scope and at this time the procedure is terminated.]]> Mohamad A. Eloubeidi, MD, Associate Professor of Medicine and Pathology, University of Alabama at Birmingham http://daveproject.org/viewfilms.cfm?film_id=881 http://daveproject.org/media/images/clip_img/180x120/vlcsnap-2009-10-17-08h18m12s233.jpg Mohamad A. Eloubeidi, MD, Associate Professor of Medicine and Pathology, University of Alabama at Birmingham Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Author: Mohamad A. Eloubeidi, M.D., M.H.S., F.A.C.P., F.A.C.G. FASGE Associate Professor of Medicine and Pathology Director, Endoscopic Ultrasound Program Co-Director Pancreatico-biliary Center Institution: University of Alabama at Birmingham Department of Medicine Division of Gastroenterology/Hepatology Statement of COI: Dr. Eloubeidi reports no conflicts of interests relating to this video presentation A 62 year old lady with pancreatic cancer was diagnosed two weeks ago at our center by EUS-guided FNA. We started her on Loretab but unfortunately it did not help her pain. During her last examination by EUS and by CT scan of the abdomen there is clear evidence of involvement of the celiac artery and therefore she is not amenable for surgical resection. We counseled her regarding the need for celiac plexus neurolysis (CPN) and she's here today to undergo CPN. Many studies published to date suggest that EUS-guided CPN is really helpful in the setting of pancreatic cancer pain and leads to success in about 70-80% of the patients. It is a safe procedure performed on outpatient basis under conscious sedation. We have given our patient a low dose of Demerol, and Verset, and we used low dose Ketamine as an adjunct to sedation. Typically we insert the echo endoscope to the level of the celiac artery where the injection is performed at its base. The echo endoscope is inserted in the patient esophagus. It was a smooth intubation. When the echoendoscope is at about 35 cm from the incisors we switch to ultrasound. The landmark we look for is really the descending aorta at about 35-40 centimeters from the incisors. The descending aorta is a tubular organ as you see here with color Doppler ultrasound. Once you identify the aorta you push forward with the echo endoscope until you find the first branching artery and that's the celiac artery. To confirm further it would be nice to demonstrate the superior mesenteric artery as you can see in this image back to back. This way you are sure you are performing the celiac neurolysis in the right area. Also for confirmatory purposes we perform color Doppler sonography to identify further the celiac artery and to be sure that there are no intervening vessels in the way. The arrow actually is a good location and estimation of where I need my needle to be to initiate the injection. I am currently using the CPN needle it's a 20 gauge needle. I think the advantages are clear with using it. In comparison to the 22 gauge needle I think we can do a quicker and faster injection. I think I crossed the wall of the stomach here and then we're going to aspirate to ensure we don't have any blood return. We are performing the injection, again it's all at the tip of the arrow- you see the needle in place. That actually created a nice cushion for us to inject the alcohol. Now here we better be sure of the needle placement since the alcohol will create a hyperechoic shadow that will block the view as you see in this image. As you see the injections really quick with this fenestrated needle we used 6ccs of bupivacaine and we injected 20 ccs of absolute alcohol in this area. We withdraw the needle from the scope and at this time the procedure is terminated.]]> Thu, 20 Aug 2009 02:08:39 EST http://daveproject.org/viewfilms.cfm?film_id=879 Matthew T. Moyer, MD, MS, Clinical Instructor, Penn State Milton S. Hershey Medical Center, Arnab Biswas, DO,, Penn State Milton S. Hershey Medical Center, Abraham Mathew, MD, Associate Professor, Penn State Milton S. Hershey Medical Center, Frank C. Lynch, MD, , Associate Professor of Radiology and Surgery, Penn State Milton S. Hershey Medical Center, Leslie B. Scorza, MD, Assistant Professor of Radiology, Surgery & Medicine, Penn State Milton S. Hershey Medical Center http://daveproject.org/viewfilms.cfm?film_id=879 http://daveproject.org/media/images/clip_img/180x120/moyer-1.jpg Matthew T. Moyer, MD, MS, Clinical Instructor, Penn State Milton S. Hershey Medical Center, Arnab Biswas, DO,, Penn State Milton S. Hershey Medical Center, Abraham Mathew, MD, Associate Professor, Penn State Milton S. Hershey Medical Center, Frank C. Lynch, MD, , Associate Professor of Radiology and Surgery, Penn State Milton S. Hershey Medical Center, Leslie B. Scorza, MD, Assistant Professor of Radiology, Surgery & Medicine, Penn State Milton S. Hershey Medical Center Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Thu, 20 Aug 2009 02:08:47 EST http://daveproject.org/viewfilms.cfm?film_id=880 Chandra S. Dasari, MD,, MD Anderson Cancer Center, Gottumukkala S. Raju, M.D., Professor of Medicine, MD Anderson Cancer Center http://daveproject.org/viewfilms.cfm?film_id=880 http://daveproject.org/media/images/clip_img/180x120/evca.i.surg.stom.eja.med.manag.jpg Chandra S. Dasari, MD,, MD Anderson Cancer Center, Gottumukkala S. Raju, M.D., Professor of Medicine, MD Anderson Cancer Center Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Wed, 12 Aug 2009 12:08:17 EST http://daveproject.org/viewfilms.cfm?film_id=878 Manmeet Padda, MD, Advanced Endoscopy Fellow, Yale University, Uzma Siddiqui, M.D., Assistant Professor of Medicine, Yale University http://daveproject.org/viewfilms.cfm?film_id=878 http://daveproject.org/media/images/clip_img/180x120/uvs090708-002.BMP Manmeet Padda, MD, Advanced Endoscopy Fellow, Yale University, Uzma Siddiqui, M.D., Assistant Professor of Medicine, Yale University Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Wed, 08 Jul 2009 03:07:53 EST http://daveproject.org/viewfilms.cfm?film_id=877 Andrea E. Reid, MD, MPH, Assistant Professor of Medicine, Harvard Medical School http://daveproject.org/viewfilms.cfm?film_id=877 http://daveproject.org/media/images/clip_img/180x120/reid_cgr_20090623.jpg Andrea E. Reid, MD, MPH, Assistant Professor of Medicine, Harvard Medical School Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Wed, 08 Jul 2009 02:07:13 EST http://daveproject.org/viewfilms.cfm?film_id=876 Patricia Sylla, MD, Instructor in Surgery, Massachusetts General Hospital http://daveproject.org/viewfilms.cfm?film_id=876 http://daveproject.org/media/images/clip_img/180x120/sylla_cgr_20090519.jpg Patricia Sylla, MD, Instructor in Surgery, Massachusetts General Hospital Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Tue, 07 Jul 2009 04:07:56 EST http://daveproject.org/viewfilms.cfm?film_id=875 Chandra S. Dasari, MD,, MD Anderson Cancer Center, Gottumukkala S. Raju, M.D., Professor of Medicine, MD Anderson Cancer Center http://daveproject.org/viewfilms.cfm?film_id=875 http://daveproject.org/media/images/clip_img/180x120/evca.d.leak.roof.dasari.ra0907.jpg Chandra S. Dasari, MD,, MD Anderson Cancer Center, Gottumukkala S. Raju, M.D., Professor of Medicine, MD Anderson Cancer Center Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Mon, 01 Jun 2009 01:06:56 EST http://daveproject.org/viewfilms.cfm?film_id=866 1. This video demonstrated a case of endoscopic resection of a distal bile duct mass. 2. A 76-yr old patient with recurrent cholangitis under went EUS for evaluation of a dilated bile duct. 3. At EUS, a hyperechoic mass was seen in the distal CBD consistent with a polyp. 4. An ERCP was undertaken to evaluate the mass by intraductal ultrasound. 5. Cholangiogram confirmed the presence of a distal CBD mass. 6. At intraductal ultrasound, a dilated CBD was seen with a hyperechoic polypoid mass sparing the deep muscle layers. 7. A biliary sphincterotomy was undertaken and extended up to the duct-duodenal junction. 8. A stone retrieval balloon was then advanced into the bile duct and the inflated balloon was pulled. 9. The bile duct mass was then gently extracted by pulling the balloon. 10. Using a polypectomy snare, the mass was resected by administration of electrocautery. 11. Using a net, the mass was retrieved successfully. 12. The resected bile duct mass measured 2 cms. 13. On histopathology, the resected mass was diagnosed to be a pyogenic granuloma of the bile duct that has not been previously reported. 14. At 6-month follow-up, the patient was doing well without any symptom recurrence.]]> Shyam S. Varadarajulu, MD,, University of Alabama at Birmingham http://daveproject.org/viewfilms.cfm?film_id=866 http://daveproject.org/media/images/clip_img/180x120/P_40_VTS_01_1-1.jpg Shyam S. Varadarajulu, MD,, University of Alabama at Birmingham Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ 1. This video demonstrated a case of endoscopic resection of a distal bile duct mass. 2. A 76-yr old patient with recurrent cholangitis under went EUS for evaluation of a dilated bile duct. 3. At EUS, a hyperechoic mass was seen in the distal CBD consistent with a polyp. 4. An ERCP was undertaken to evaluate the mass by intraductal ultrasound. 5. Cholangiogram confirmed the presence of a distal CBD mass. 6. At intraductal ultrasound, a dilated CBD was seen with a hyperechoic polypoid mass sparing the deep muscle layers. 7. A biliary sphincterotomy was undertaken and extended up to the duct-duodenal junction. 8. A stone retrieval balloon was then advanced into the bile duct and the inflated balloon was pulled. 9. The bile duct mass was then gently extracted by pulling the balloon. 10. Using a polypectomy snare, the mass was resected by administration of electrocautery. 11. Using a net, the mass was retrieved successfully. 12. The resected bile duct mass measured 2 cms. 13. On histopathology, the resected mass was diagnosed to be a pyogenic granuloma of the bile duct that has not been previously reported. 14. At 6-month follow-up, the patient was doing well without any symptom recurrence.]]> Mon, 01 Jun 2009 01:06:55 EST http://daveproject.org/viewfilms.cfm?film_id=865 Gregory A. Cote, MD, MS,, University of Washington http://daveproject.org/viewfilms.cfm?film_id=865 http://daveproject.org/media/images/clip_img/180x120/P_31_R2_Cholangioscopy-1.jpg Gregory A. Cote, MD, MS,, University of Washington Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Mon, 01 Jun 2009 01:06:54 EST http://daveproject.org/viewfilms.cfm?film_id=864 Amit P. Maydeo, MD,, Institute of Advanced Endoscopy http://daveproject.org/viewfilms.cfm?film_id=864 http://daveproject.org/media/images/clip_img/180x120/P_30_VTS_01_11.jpg Amit P. Maydeo, MD,, Institute of Advanced Endoscopy Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/ Mon, 01 Jun 2009 01:06:53 EST http://daveproject.org/viewfilms.cfm?film_id=863 Guido Costamagna, MD,, Catholic University, Rome http://daveproject.org/viewfilms.cfm?film_id=863 http://daveproject.org/media/images/clip_img/180x120/P_27_Costamagna.jpg Guido Costamagna, MD,, Catholic University, Rome Science : Educational Resources : Gastroenterology http://creativecommons.org/licenses/by-nc-sa/2.0/