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Intussuception in Peutz-Jegher Syndrom
Mike Babineaux, MD : 21 Jan 2010
A 30 year old woman with Peutz-Jegher syndrome presented with nausea, vomiting and crampy left abdominal pain. She had undergone multiple abdominal surgeries since child hood for intussuception of the small bowel due to large hamartomatous polyps. Her physical exam was remarkable for tachycardia, hyperpigmented spots on her lips and an abdomen tender to deep palpation with no rebound tenderness..... view more....
Mike Babineaux, MD : 21 Jan 2010
A 30 year old woman with Peutz-Jegher syndrome presented with nausea, vomiting and crampy left abdominal pain. She had undergone multiple abdominal surgeries since child hood for intussuception of the small bowel due to large hamartomatous polyps. Her physical exam was remarkable for tachycardia, hyperpigmented spots on her lips and an abdomen tender to deep palpation with no rebound tenderness..... view more....
Duodenum - Endoscopic Management of a Windsock Diveticulum
Rajesh N. Keswani, MD : 19 Jan 2010
A 24 year old female was referred for complaints intermittent nausea and vomiting and weight loss. The upper GI barium study demonstrates an enlarged diverticulum in the second portion of the duodenum. A thin radiolucent stripe is seen around the diverticulum which has been described as the halo sign. Upper endoscopy is performed which identifies a large diverticulum which intermittently obstructs.... view more....
Rajesh N. Keswani, MD : 19 Jan 2010
A 24 year old female was referred for complaints intermittent nausea and vomiting and weight loss. The upper GI barium study demonstrates an enlarged diverticulum in the second portion of the duodenum. A thin radiolucent stripe is seen around the diverticulum which has been described as the halo sign. Upper endoscopy is performed which identifies a large diverticulum which intermittently obstructs.... view more....
Intestine - EUS of an Appendiceal Adenoma
Jonathan M Buscaglia, MD : 13 Jan 2010
On routine examination of the cecum during screening colonoscopy, a 76 year-old man is noted to have a small amount of polypoid tissue extruding from the appendiceal orifice. The lesion is submerged in water and a 20 MHz, high-frequency, EUS probe is used for further evaluation. EUS allows for easy sonographic identification of the polyp. The bright white, hyperechoic portions of the colonic wall.... view more....
Jonathan M Buscaglia, MD : 13 Jan 2010
On routine examination of the cecum during screening colonoscopy, a 76 year-old man is noted to have a small amount of polypoid tissue extruding from the appendiceal orifice. The lesion is submerged in water and a 20 MHz, high-frequency, EUS probe is used for further evaluation. EUS allows for easy sonographic identification of the polyp. The bright white, hyperechoic portions of the colonic wall.... view more....
Pure Wire Guided Cannulation of the Bile Duct Using a Loop-tip Guidewire
Kapil Gupta, M.D. : 08 Dec 2009
In this video we will present two cases discussing the technique of bile duct access with pure wire guided cannulation using a loop tip guide wire. For pure wire guided cannulation, a sphincterotome is recommended. We should stay slightly away from the papilla so that papilla is clearly visualized and using the bow of sphincterotome the guide wire can be advanced in a cephalad direction over the.... view more....
Kapil Gupta, M.D. : 08 Dec 2009
In this video we will present two cases discussing the technique of bile duct access with pure wire guided cannulation using a loop tip guide wire. For pure wire guided cannulation, a sphincterotome is recommended. We should stay slightly away from the papilla so that papilla is clearly visualized and using the bow of sphincterotome the guide wire can be advanced in a cephalad direction over the.... view more....
Large Diameter Balloon Dilation for Removal of Bile Duct Stone
Manmeet Padda, MD : 20 Nov 2009
83 year old male with multiple co-morbidities presented with fever, abnormal liver enzymes and dilated common bile duct (CBD) up to 15 mm in size on abdominal CT scan and elevated international normalized ratio (INR). A pull type sphincterotome was used to cannulate the common bile duct. After the slight adjustment, the sphincterotome was advanced freely without any resistance into the common bi.... view more....
Manmeet Padda, MD : 20 Nov 2009
83 year old male with multiple co-morbidities presented with fever, abnormal liver enzymes and dilated common bile duct (CBD) up to 15 mm in size on abdominal CT scan and elevated international normalized ratio (INR). A pull type sphincterotome was used to cannulate the common bile duct. After the slight adjustment, the sphincterotome was advanced freely without any resistance into the common bi.... view more....
EUS FNA of a Pancreatic Neuroendocrine Tumor
Alina Stoita, MBBS : 20 Nov 2009
A 67 year old man was referred for an EUS of an incidental pancreatic mass lesion. His past medical history included a colorectal cancer resected 18 year ago. He was admitted to the hospital 1 month prior to the EUS for one episode of melaena. He had no weight loss and was otherwise well. He had a normal gastroscopy and colonoscopy and a capsule endoscopy showed a small bowel polyp. To further.... view more....
Alina Stoita, MBBS : 20 Nov 2009
A 67 year old man was referred for an EUS of an incidental pancreatic mass lesion. His past medical history included a colorectal cancer resected 18 year ago. He was admitted to the hospital 1 month prior to the EUS for one episode of melaena. He had no weight loss and was otherwise well. He had a normal gastroscopy and colonoscopy and a capsule endoscopy showed a small bowel polyp. To further.... view more....
Pancreatic Sphincterotomy and Stent Placement for a Communicating Pseudocyst
Jonathan M Buscaglia, MD : 20 Nov 2009
ERCP is attempted for transpapillary drainage of a communicating pseudocyst. Cannulation of the pancreatic orifice is performed using a standard sphincterotome. Injection pancreatogram reveals a gush of contrast extravasating from the main pancreatic duct. A large amount of contrast is seen pooling behind the endoscope. A decision is made to perform a pancreatic sphincterotomy and place a pancrea.... view more....
Jonathan M Buscaglia, MD : 20 Nov 2009
ERCP is attempted for transpapillary drainage of a communicating pseudocyst. Cannulation of the pancreatic orifice is performed using a standard sphincterotome. Injection pancreatogram reveals a gush of contrast extravasating from the main pancreatic duct. A large amount of contrast is seen pooling behind the endoscope. A decision is made to perform a pancreatic sphincterotomy and place a pancrea.... view more....
EUS for Staging of Rectal Cancer
Jonathan M Buscaglia, MD : 09 Nov 2009
A 72 year-old man is found to have a rectal adenocarcinoma on screening colonoscopy. CT scan of the abdomen and pelvis is performed and shows evidence of rectal wall thickening without associated lymphadenopathy. Subsequent PET scan shows increased activity in the rectum only. Staging pull-through EUS examination is then performed. Radial imaging at 7.5 MHz shows clear identification of the bladde.... view more....
Jonathan M Buscaglia, MD : 09 Nov 2009
A 72 year-old man is found to have a rectal adenocarcinoma on screening colonoscopy. CT scan of the abdomen and pelvis is performed and shows evidence of rectal wall thickening without associated lymphadenopathy. Subsequent PET scan shows increased activity in the rectum only. Staging pull-through EUS examination is then performed. Radial imaging at 7.5 MHz shows clear identification of the bladde.... view more....
Transgastric Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis
B. Joseph Elmunzer, MD : 28 Oct 2009
The patient is a 61 year-old gentleman with multiple medical problems, including end stage renal disease requiring a deceased donor kidney transplant, who developed walled-off pancreatic necrosis four months after an episode of severe gallstone pancreatitis. He developed progressive anorexia, early satiety, and post-prandial nausea, leading to profound weight loss despite nutritional supplemen.... view more....
B. Joseph Elmunzer, MD : 28 Oct 2009
The patient is a 61 year-old gentleman with multiple medical problems, including end stage renal disease requiring a deceased donor kidney transplant, who developed walled-off pancreatic necrosis four months after an episode of severe gallstone pancreatitis. He developed progressive anorexia, early satiety, and post-prandial nausea, leading to profound weight loss despite nutritional supplemen.... view more....
Esophagus - Band Ligation of Actively Bleeding Gastroesophageal Varices
Lauren Layer : 28 Oct 2009
A 53-year old female with hepatitis C, alcohol abuse, and child C cirrhosis presented with hematemesis for one day. Vital signs on admission were a blood pressure of 100/66 and heart rate of 110. Laboratory results were hemoglobin: 10 g/dL, platelets: 89,000, and INR: 2.8. She had a previous history of esophageal varices without any bleeding or history of variceal banding. Initial management c.... view more....
Lauren Layer : 28 Oct 2009
A 53-year old female with hepatitis C, alcohol abuse, and child C cirrhosis presented with hematemesis for one day. Vital signs on admission were a blood pressure of 100/66 and heart rate of 110. Laboratory results were hemoglobin: 10 g/dL, platelets: 89,000, and INR: 2.8. She had a previous history of esophageal varices without any bleeding or history of variceal banding. Initial management c.... view more....
Pseudomelanosis
Mohammad Bilal : 21 Oct 2009
During a routine endoscopy for Barrett's related dysplasia surveillance, this mucosal abnormality was identified. On endoscopy, these pigmented areas of mucosa in the antrum, pylorus, and duodenum were seen. This is the classic endoscopic finding of pseudomelanosis of the gastrointestinal tract, whose features include a brownish-black pigmentation of the mucosa in a non-inflamed, random, sp.... view more....
Mohammad Bilal : 21 Oct 2009
During a routine endoscopy for Barrett's related dysplasia surveillance, this mucosal abnormality was identified. On endoscopy, these pigmented areas of mucosa in the antrum, pylorus, and duodenum were seen. This is the classic endoscopic finding of pseudomelanosis of the gastrointestinal tract, whose features include a brownish-black pigmentation of the mucosa in a non-inflamed, random, sp.... view more....
Case Study: Endoscopic Ultrasound (EUS) Guided-Celiac Plexus Neurolysis (CPN)
Mohamad A. Eloubeidi, MD : 19 Oct 2009
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 relatin.... view more....
Mohamad A. Eloubeidi, MD : 19 Oct 2009
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 relatin.... view more....
Pancreas - Advancing the Principles of Minimally Invasive Surgical Therapy: A Percutaneous, Combined IR / Flexible Endoscopic Pancreatic Necrosectomy
Matthew T. Moyer, MD, MS : 20 Aug 2009
Our video aims to review the combined interventional radiographic and endoscopic techniques used to perform a percutaneous retroperitoneal necrosectomy in a patient with severe necrotizing pancreatitis. The five minimally invasive tenants of the procedure will be demonstrated: " Using interventional techniques to establish a retroperitoneal access site that will allow repeated endoscopic access..... view more....
Matthew T. Moyer, MD, MS : 20 Aug 2009
Our video aims to review the combined interventional radiographic and endoscopic techniques used to perform a percutaneous retroperitoneal necrosectomy in a patient with severe necrotizing pancreatitis. The five minimally invasive tenants of the procedure will be demonstrated: " Using interventional techniques to establish a retroperitoneal access site that will allow repeated endoscopic access..... view more....
Intestine - Total Gastrectomy with Esophagojejunostomy
Chandra S. Dasari, MD : 20 Aug 2009
The following video demonstrates the medical management of total gastrectomy with esophagojejunostomy. These are the two different types of esophago jejunostomies. This is a simple Roux-en-Y esophagojejunostomy. It has a short blind loop and a patent loop of jejunum. We will now see the endoscopic view of a simple Roux-en-Y esophagojejunostomy in a 73 year old female patient who underwent total.... view more....
Chandra S. Dasari, MD : 20 Aug 2009
The following video demonstrates the medical management of total gastrectomy with esophagojejunostomy. These are the two different types of esophago jejunostomies. This is a simple Roux-en-Y esophagojejunostomy. It has a short blind loop and a patent loop of jejunum. We will now see the endoscopic view of a simple Roux-en-Y esophagojejunostomy in a 73 year old female patient who underwent total.... view more....
Biliary - Multiple Liver Microabscesses in Malignant Biliary Obstruction; EUS view
Manmeet Padda, MD : 12 Aug 2009
Our case is a 75 year old male who presented with obstructive jaundice, fever, and leukocytosis with bandemia. CT scan of the abdomen showed common bile duct and pancreatic duct dilation. There was a large pancreatic mass seen along with multiple liver lesions. Here in the abdominal CT scan the red arrows are pointing at multiple small loculated fluid collections. Here you see the distal commo.... view more....
Manmeet Padda, MD : 12 Aug 2009
Our case is a 75 year old male who presented with obstructive jaundice, fever, and leukocytosis with bandemia. CT scan of the abdomen showed common bile duct and pancreatic duct dilation. There was a large pancreatic mass seen along with multiple liver lesions. Here in the abdominal CT scan the red arrows are pointing at multiple small loculated fluid collections. Here you see the distal commo.... view more....
Racial and Ethnic Disparities in Liver Disease
Andrea E. Reid, MD, MPH : 08 Jul 2009
Dr Andrea Reid, Gastroenterology Program Director at Massachusetts General Hospital, presented clinical grand rounds on the topic of "Racial and Ethnic Disparities in Liver Disease". Issues discussed include hepatitis B, hepatitis C, NAFLD, hepatocellular carcinoma, and liver transplantation. The lecture was recorded June 23, 2009..... view more....
Andrea E. Reid, MD, MPH : 08 Jul 2009
Dr Andrea Reid, Gastroenterology Program Director at Massachusetts General Hospital, presented clinical grand rounds on the topic of "Racial and Ethnic Disparities in Liver Disease". Issues discussed include hepatitis B, hepatitis C, NAFLD, hepatocellular carcinoma, and liver transplantation. The lecture was recorded June 23, 2009..... view more....
NOTES Transrectal Rectosigmoid Resection
Patricia Sylla, MD : 08 Jul 2009
Dr Patricia Sylla, Instructor in Surgery at Massachusetts General Hospital, delivered clinical grand rounds at the MGH GI Unit on the topic of transrectal rectosigmoid resection via NOTES. The lecture was recorded May 19, 2009..... view more....
Patricia Sylla, MD : 08 Jul 2009
Dr Patricia Sylla, Instructor in Surgery at Massachusetts General Hospital, delivered clinical grand rounds at the MGH GI Unit on the topic of transrectal rectosigmoid resection via NOTES. The lecture was recorded May 19, 2009..... view more....
Duodenum - Leaking Roof Concept of Duodenal Ulcers
Chandra S. Dasari, MD : 07 Jul 2009
The following video demonstrates the endoscopic view of a duodenal ulcer and a look at its pathogenesis by reviewing The leaking roof concept by C. S. Goodwin. The most important causative factor for a duodenal ulcer is Helicobacter pylori. Endoscopic view of a DU. The endoscope is in the duodenum. Retracting the scope from the second part of the duodenum slowly into the duodenal bulb showed.... view more....
Chandra S. Dasari, MD : 07 Jul 2009
The following video demonstrates the endoscopic view of a duodenal ulcer and a look at its pathogenesis by reviewing The leaking roof concept by C. S. Goodwin. The most important causative factor for a duodenal ulcer is Helicobacter pylori. Endoscopic view of a DU. The endoscope is in the duodenum. Retracting the scope from the second part of the duodenum slowly into the duodenal bulb showed.... view more....
Endoscopic Resection of Distal Bile Duct Mass
Shyam S. Varadarajulu, MD : 01 Jun 2009
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.... view more....
Shyam S. Varadarajulu, MD : 01 Jun 2009
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.... view more....
Direct Peroral Cholangioscopy in the Management of Refractory Stone Disease
Gregory A. Cote, MD, MS : 01 Jun 2009
Direct, peroral cholangioscopy in the management of refractory stone disease, presented by Gregory Cote, Steven Edmundowicz, Sreenivasa Jonnalagadda and Riad Azar. Cholangioscopy allows direct visualization of the bile duct; this has been used to distinguish malignant from benign bile duct lesions, as wall as in the management of complicated choledocholithiasis by allowing direct visualization for.... view more....
Gregory A. Cote, MD, MS : 01 Jun 2009
Direct, peroral cholangioscopy in the management of refractory stone disease, presented by Gregory Cote, Steven Edmundowicz, Sreenivasa Jonnalagadda and Riad Azar. Cholangioscopy allows direct visualization of the bile duct; this has been used to distinguish malignant from benign bile duct lesions, as wall as in the management of complicated choledocholithiasis by allowing direct visualization for.... view more....
Pancreatic Balloon Sphincteroplasty For Removal of Large Radiolucent Pancreatic Stones
Amit P. Maydeo, MD : 01 Jun 2009
We describe here a technique of endoscopy large balloon sphincteroplasty for removing large radiolucent pancreatic stones. A 18Yrs old male patient with symptomatic large radiolucent pancreatic stones underwent a MRCP and then an ERCP for stone extraction. ERCP was started in left lateral position with a normal cannula for cannulating the pancreatic duct. After turning the patient in the supine p.... view more....
Amit P. Maydeo, MD : 01 Jun 2009
We describe here a technique of endoscopy large balloon sphincteroplasty for removing large radiolucent pancreatic stones. A 18Yrs old male patient with symptomatic large radiolucent pancreatic stones underwent a MRCP and then an ERCP for stone extraction. ERCP was started in left lateral position with a normal cannula for cannulating the pancreatic duct. After turning the patient in the supine p.... view more....
Endoscopic Anastomosis Between the Cystic Duct Stump and a Severed Aberrant Right Hepatic Duct
Guido Costamagna, MD : 01 Jun 2009
A 57 year old patient underwent cholecystectomy and colonic resection for a neoplasm in November 2007. Post operative course was complicated by a post-operative biliary leak. An ERCP was performed and showed a complete transaction of posterolateral sectorial bile duct. Fistula output reduced significantly after a percutaneous drainage of the severed duct but a low volume leak eventually pers.... view more....
Guido Costamagna, MD : 01 Jun 2009
A 57 year old patient underwent cholecystectomy and colonic resection for a neoplasm in November 2007. Post operative course was complicated by a post-operative biliary leak. An ERCP was performed and showed a complete transaction of posterolateral sectorial bile duct. Fistula output reduced significantly after a percutaneous drainage of the severed duct but a low volume leak eventually pers.... view more....
Therapeutic EUS for the Treatment of a Pancreaticopleural Fistual
Scott T. Cooper, MD : 01 Jun 2009
Scott Cooper was given Material Support from Pentax Medical Company Pancreatic duct injuries can often be successfully treated by endoscopic retrograde pancreaotography or ERP with pancreatic stent insertion. Unlike biliary strictures where perctuaneous transhepatic cholangography is an option after failed endoscopic retrograde cholaniography (ERC), such options are not available after failed E.... view more....
Scott T. Cooper, MD : 01 Jun 2009
Scott Cooper was given Material Support from Pentax Medical Company Pancreatic duct injuries can often be successfully treated by endoscopic retrograde pancreaotography or ERP with pancreatic stent insertion. Unlike biliary strictures where perctuaneous transhepatic cholangography is an option after failed endoscopic retrograde cholaniography (ERC), such options are not available after failed E.... view more....
Direct Pancreatoscopy with Narrow Band Imaging in Patient with Pancreas Divisum and Intraductal Papillary Mucinous Neoplasm
Daniel A. Ringold, MD : 01 Jun 2009
Intraductal Papillary Mucinous Neoplasia are recently recognized pancreatic tumors that present as 3 main subtypes. The first type involves the main pancreatic duct only. The second type only affects the side-branches. And the third is a mixed type involving both the main duct and the side-branches. Main duct IPMN is the most commonly recognized type due to accompanying presenting symptoms such as.... view more....
Daniel A. Ringold, MD : 01 Jun 2009
Intraductal Papillary Mucinous Neoplasia are recently recognized pancreatic tumors that present as 3 main subtypes. The first type involves the main pancreatic duct only. The second type only affects the side-branches. And the third is a mixed type involving both the main duct and the side-branches. Main duct IPMN is the most commonly recognized type due to accompanying presenting symptoms such as.... view more....
Digital Cholangioscopy with Narrow Band Imaging and Confocal Microscopy
Ram Chuttani, M.D. : 01 Jun 2009
Cholangioscopy for direct visualization of the biliary tract can be performed perorally, percutaneously or intraoperatively. Perorally we may use a semi-disposable fiber optic system, or reusable fiberoptic or digital system. Cholangioscopy diagnostically can characterize strictures, determine tumor extension and help in the detection of occult cancers in PSC. Therapeutic applications include mana.... view more....
Ram Chuttani, M.D. : 01 Jun 2009
Cholangioscopy for direct visualization of the biliary tract can be performed perorally, percutaneously or intraoperatively. Perorally we may use a semi-disposable fiber optic system, or reusable fiberoptic or digital system. Cholangioscopy diagnostically can characterize strictures, determine tumor extension and help in the detection of occult cancers in PSC. Therapeutic applications include mana.... view more....
EUS-guided Biliary Drainage with One-step Placement of Newly Designed Fully Covered Metal Stent for Malignant Biliary Obstruction: A Prospective Feasibility Study
Do Hyun Park, M.D. PhD : 01 Jun 2009
EUS-guided biliary drainage (EUD) has been introduced for and alternative to percutaneous transhepatic biliary drainage (PTBD) in case of biliary obstruction when ERCP is unsuccessful. However, results of EUS-guided biliary drainage with placement of plastic stent may have a frequent re-intervention rate due to the stent dysfunction. Although self expandable metallic stent with a larger dia.... view more....
Do Hyun Park, M.D. PhD : 01 Jun 2009
EUS-guided biliary drainage (EUD) has been introduced for and alternative to percutaneous transhepatic biliary drainage (PTBD) in case of biliary obstruction when ERCP is unsuccessful. However, results of EUS-guided biliary drainage with placement of plastic stent may have a frequent re-intervention rate due to the stent dysfunction. Although self expandable metallic stent with a larger dia.... view more....
Advanced Endoscopic Pancreaticobiliary Therapy in Surgically-Altered Enteral Anatomy
Marvin Ryou, MD : 01 Jun 2009
This video will present a series of cases highlighting techniques and devices useful in the endoscopic treatment of pancreaticobiliary disorders in the setting of post-surgical anatomy. Post-surgical anatomy can present challenges to endoscopic pancreaticobiliary therapy. For example, there can be extensive re-routing to the cannulation site such as in RY anatomy or Bilroth anatomy. Another pro.... view more....
Marvin Ryou, MD : 01 Jun 2009
This video will present a series of cases highlighting techniques and devices useful in the endoscopic treatment of pancreaticobiliary disorders in the setting of post-surgical anatomy. Post-surgical anatomy can present challenges to endoscopic pancreaticobiliary therapy. For example, there can be extensive re-routing to the cannulation site such as in RY anatomy or Bilroth anatomy. Another pro.... view more....
Peroral Cholangioscopy: Removal of Foreign Body From Biliary Tree
Shahzad Iqbal, MD : 01 Jun 2009
This is a 30 years old patient with history of abdominal gunshot wound about 5 years ago, who was admitted with recurrent abdominal pain and elevated liver enzymes. Scout film showed a foreign body near hepatic duct bifurcation. The extrahepatic biliary tree was diffusely narrowed. A dominant Hilar stricture was seen at the site of foreign body with upstream intrahepatic biliary dilation. The fore.... view more....
Shahzad Iqbal, MD : 01 Jun 2009
This is a 30 years old patient with history of abdominal gunshot wound about 5 years ago, who was admitted with recurrent abdominal pain and elevated liver enzymes. Scout film showed a foreign body near hepatic duct bifurcation. The extrahepatic biliary tree was diffusely narrowed. A dominant Hilar stricture was seen at the site of foreign body with upstream intrahepatic biliary dilation. The fore.... view more....
Endoluminal Treatment of Obesity: First Case Report of Transoral Gastroplasty in the US
Gregory A. Cote, MD, MS : 01 Jun 2009
The obesity epidemic now affects 30% of the adult population in the U.S., approximately 60 million Americans. Bariatric surgery remains the most effective treatment to date. Endoluminal therapies present an opportunity for a less invasive approach. Transoral gastroplasty, or TOGA, combines two flexible, endoscopic staplers that can be used to create a restrictive gastric pouch, giving patien.... view more....
Gregory A. Cote, MD, MS : 01 Jun 2009
The obesity epidemic now affects 30% of the adult population in the U.S., approximately 60 million Americans. Bariatric surgery remains the most effective treatment to date. Endoluminal therapies present an opportunity for a less invasive approach. Transoral gastroplasty, or TOGA, combines two flexible, endoscopic staplers that can be used to create a restrictive gastric pouch, giving patien.... view more....
Feasibility of Small Bowel Resection by NOTES Transgastric and Transvaginal Approach
Elena Dubcenco, MD : 01 Jun 2009
This experiment was aimed to demonstrate the technical feasibility of NOTES small bowel resection via a combined transgastric-transvaginal approach. The procedure was performed in a laboratory setting of the Johns Hopkins University School of Medicine. Acute porcine model was used. A pig was placed on the operating table in the supine position. Pneumoperitoneum was established using a laparo.... view more....
Elena Dubcenco, MD : 01 Jun 2009
This experiment was aimed to demonstrate the technical feasibility of NOTES small bowel resection via a combined transgastric-transvaginal approach. The procedure was performed in a laboratory setting of the Johns Hopkins University School of Medicine. Acute porcine model was used. A pig was placed on the operating table in the supine position. Pneumoperitoneum was established using a laparo.... view more....
NOTES Transgastric Hernia Repair in a Porcine Model
David J. Desilets, MD, PhD : 01 Jun 2009
Our procedure begins with a PEG-type transgastric abdominal access. A wire is placed percutaneously into the stomach, a balloon is passed over the wire into the abdominal cavity, and the balloon is inflated. The endoscope exits the stomach into the abdominal cavity by following the balloon as we push out over the guidewire. Once the Savary is in place, the endoscope is removed and the mesh introdu.... view more....
David J. Desilets, MD, PhD : 01 Jun 2009
Our procedure begins with a PEG-type transgastric abdominal access. A wire is placed percutaneously into the stomach, a balloon is passed over the wire into the abdominal cavity, and the balloon is inflated. The endoscope exits the stomach into the abdominal cavity by following the balloon as we push out over the guidewire. Once the Savary is in place, the endoscope is removed and the mesh introdu.... view more....
Lower Gastrointestinal Bleeding in a Post Kidney Pancreas Transplant Patient
Srikrishna Vemana, MD : 01 Jun 2009
We would like to start by presenting a rare case of gastrointestinal bleeding post combined kidney-pancreas transplantation. This is a 43 y/o male with a history of kidney-pancreas transplantation in 2002 and failed graft functioning over time. He was seen several weeks prior to presentation at our institution with hematochezia. He had an upper endoscopy and colonoscopy which were significant f.... view more....
Srikrishna Vemana, MD : 01 Jun 2009
We would like to start by presenting a rare case of gastrointestinal bleeding post combined kidney-pancreas transplantation. This is a 43 y/o male with a history of kidney-pancreas transplantation in 2002 and failed graft functioning over time. He was seen several weeks prior to presentation at our institution with hematochezia. He had an upper endoscopy and colonoscopy which were significant f.... view more....
Endoscopic Treatment of Gallstone Illeus of the Colon
Todd H. Baron, M.D. : 01 Jun 2009
The patient presented with a large impaction of a stone in the sigmoid colon. Endoscopically an electrohydraulic lithotripter device was used under saline irrigation in attempt to fragment the stone. Here you can see fragmentation of the stone. Large diverticula can be seen which were the cause of the stone impaction in the sigmoid colon. A large number of shocks were delivered to the stone in att.... view more....
Todd H. Baron, M.D. : 01 Jun 2009
The patient presented with a large impaction of a stone in the sigmoid colon. Endoscopically an electrohydraulic lithotripter device was used under saline irrigation in attempt to fragment the stone. Here you can see fragmentation of the stone. Large diverticula can be seen which were the cause of the stone impaction in the sigmoid colon. A large number of shocks were delivered to the stone in att.... view more....
Enteral Stent Placement Using Spiral Enteroscopy for Malignant Mid-jejunal Obstruction
Eun J. Shin, MD : 01 Jun 2009
This is a case of a 47 year-old female with metastatic colon adenocarcinoma who was admitted with intractable nausea and vomiting with per oral intake. Upper GI study abdominal CT scan demonstrated a small bowel obstruction with a transition point in the proximal-mid jejunum. She was deemed to be a poor operative candidate and the decision was made to attempt an enteroscopy with enteral stent p.... view more....
Eun J. Shin, MD : 01 Jun 2009
This is a case of a 47 year-old female with metastatic colon adenocarcinoma who was admitted with intractable nausea and vomiting with per oral intake. Upper GI study abdominal CT scan demonstrated a small bowel obstruction with a transition point in the proximal-mid jejunum. She was deemed to be a poor operative candidate and the decision was made to attempt an enteroscopy with enteral stent p.... view more....
Endoscopic Repair of a Type II Paraesophageal Hernia with Mesenteroaxial Volvulus
Keith L. Obstein, MD : 01 Jun 2009
In the following video we present the case of a 65 year old man with multiple medical comorbidities admitted to the hospital after acute onset of abdominal discomfort, nausea, vomiting, inability to tolerate an oral diet and “coffee ground” emesis A Computed Tomorgraphy (CT) scan was performed. On coronal view, we see the dilated gastric body below the diaphragm, the fixed gastro.... view more....
Keith L. Obstein, MD : 01 Jun 2009
In the following video we present the case of a 65 year old man with multiple medical comorbidities admitted to the hospital after acute onset of abdominal discomfort, nausea, vomiting, inability to tolerate an oral diet and “coffee ground” emesis A Computed Tomorgraphy (CT) scan was performed. On coronal view, we see the dilated gastric body below the diaphragm, the fixed gastro.... view more....
Endoscopic Mangement of a Tubular Esophageal Duplication Diagnosed in a 14 Year Old Male
Dimitri Coumaros, MD : 01 Jun 2009
We report the case of a 14-year-old male with a medical history of two episodes of epigastric pain at the age of 6 and 9 years that were relieved with PPI's administration. He also had to make permanent changes in his eating habits such as avoiding meat. He presented with acute dysphagia to solids and liquids and acute retrosternal pain. On barium oesophagogram, double-lumen esophagus was.... view more....
Dimitri Coumaros, MD : 01 Jun 2009
We report the case of a 14-year-old male with a medical history of two episodes of epigastric pain at the age of 6 and 9 years that were relieved with PPI's administration. He also had to make permanent changes in his eating habits such as avoiding meat. He presented with acute dysphagia to solids and liquids and acute retrosternal pain. On barium oesophagogram, double-lumen esophagus was.... view more....
Endoscopic Mediastinal Abscess Drainage
Arnab Biswas, DO : 01 Jun 2009
Background 1 Endoscopic necrosectomy of complicated pancreatic pseudosustic collections have been demonstrated to be a safe primary treatment of necrosis and abscess collections. 2 Transgastric access technique has revolutionized the role of interventional endoscopy in a variety of cases where surgery is too risk or contraindicated. 3 We describe a case of endoscopic trans-gastric treatment.... view more....
Arnab Biswas, DO : 01 Jun 2009
Background 1 Endoscopic necrosectomy of complicated pancreatic pseudosustic collections have been demonstrated to be a safe primary treatment of necrosis and abscess collections. 2 Transgastric access technique has revolutionized the role of interventional endoscopy in a variety of cases where surgery is too risk or contraindicated. 3 We describe a case of endoscopic trans-gastric treatment.... view more....
Loop-and-let-go for Gastric GISTs
Kenneth F. Binmoeller, MD : 01 Jun 2009
Although GISTS comprise only 1% of gastrointestinal tract tumors, two-thirds are located in the stomach, constituting 5% of gastric tumors. It is estimated that between 5- 6,000 new cases are diagnosed per year. This number will increase as more GISTS are found incidentally on upper endoscopy. EUS plays a crucial role in the evaluation, diagnosis, and potential management of GISTs. A GIST t.... view more....
Kenneth F. Binmoeller, MD : 01 Jun 2009
Although GISTS comprise only 1% of gastrointestinal tract tumors, two-thirds are located in the stomach, constituting 5% of gastric tumors. It is estimated that between 5- 6,000 new cases are diagnosed per year. This number will increase as more GISTS are found incidentally on upper endoscopy. EUS plays a crucial role in the evaluation, diagnosis, and potential management of GISTs. A GIST t.... view more....
EUS-guided Coil Embolization of Gastric Varices after Unsuccessful Endoscopic Glue Injection
Andres Sanchez-Yague, MD, PhD : 01 Jun 2009
Bleeding from gastric varices is associated with significant morbidity and mortality. Management of bleeding gastric varices is difficult due to their large size and the severity of bleeding. Treatment options include creatin of a porto-systemic shunt by means of TIPS or surgery and endoscopic interventions. A 43-year-old male with a past medical history of cirrhosis and prior bleeding fro.... view more....
Andres Sanchez-Yague, MD, PhD : 01 Jun 2009
Bleeding from gastric varices is associated with significant morbidity and mortality. Management of bleeding gastric varices is difficult due to their large size and the severity of bleeding. Treatment options include creatin of a porto-systemic shunt by means of TIPS or surgery and endoscopic interventions. A 43-year-old male with a past medical history of cirrhosis and prior bleeding fro.... view more....
Endoscopic Submucosal Dissection with a Water-jet Hybrid Knife (ESDH) of Mucosal and Submucosal Lesion in the Upper GI Tract
Horst Neuhaus, MD : 01 Jun 2009
We report on endoscopic submucosal dissection with a water-jet HybridKnife (ESDH) of mucosal and submucosal lesion in the upper GI tract This animation shows the principle of ESDH. The tipof the HybridKnife is used for setting coagulation markers with safety margins around the targeted lesion. The knife is then positioned close to some of the markers. Activation of the food-switched control.... view more....
Horst Neuhaus, MD : 01 Jun 2009
We report on endoscopic submucosal dissection with a water-jet HybridKnife (ESDH) of mucosal and submucosal lesion in the upper GI tract This animation shows the principle of ESDH. The tipof the HybridKnife is used for setting coagulation markers with safety margins around the targeted lesion. The knife is then positioned close to some of the markers. Activation of the food-switched control.... view more....
