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Celiac Disease: Modern Lessons from an Ancient Disease
Daniel Leffler MD, MS : 17 Aug 2010
Dr Daniel Leffler, Director of Clinical Research of the The Celiac Center at Beth Israel Deaconess Medical Center, presented clinical grand rounds at the MGH GI Unit on the topic of celiac disease. The presentation was recorded June 22, 2010..... view more....
Daniel Leffler MD, MS : 17 Aug 2010
Dr Daniel Leffler, Director of Clinical Research of the The Celiac Center at Beth Israel Deaconess Medical Center, presented clinical grand rounds at the MGH GI Unit on the topic of celiac disease. The presentation was recorded June 22, 2010..... view more....
Infliximab, Azathioprine, or Combination Therapy for Crohns Disease
Parantap Gupta, MD : 17 Aug 2010
Dr. Parantap Gupta, GI Fellow at Stony Brook University Medical Center, reviewed the article from April 2010 in the New England Journal of Medicine titled "Infliximab, Azathioprine, or Combination Therapy for Crohn's Disease"..... view more....
Parantap Gupta, MD : 17 Aug 2010
Dr. Parantap Gupta, GI Fellow at Stony Brook University Medical Center, reviewed the article from April 2010 in the New England Journal of Medicine titled "Infliximab, Azathioprine, or Combination Therapy for Crohn's Disease"..... view more....
Rifaximin Treatment in Hepatic Encephalopathy
Parantap Gupta, MD : 17 Aug 2010
Dr Parantap Gupta, GI Fellow at Stony Brook Medical Center, reviews the March 2010 article from the New England Journal of Medicine titled "Rifaximin treatment in hepatic encephalopathy".... view more....
Parantap Gupta, MD : 17 Aug 2010
Dr Parantap Gupta, GI Fellow at Stony Brook Medical Center, reviews the March 2010 article from the New England Journal of Medicine titled "Rifaximin treatment in hepatic encephalopathy".... view more....
Peroral Cholangioscopy in Bllroth II Gastrectomy
Dr. Quan Wai Leong : 11 Aug 2010
This is a 68 yr old Chinese man with a background history of Billroth II gastrectomy presented recently with a severe acute cholangitis. An ERCP was performed and a plastic stent was inserted for biliary drainage. He has now returned for a repeat ERCP. The initial duodenoscopic view showed only one small opening which we thought would most likely represent the afferent limb. A more detailed sea.... view more....
Dr. Quan Wai Leong : 11 Aug 2010
This is a 68 yr old Chinese man with a background history of Billroth II gastrectomy presented recently with a severe acute cholangitis. An ERCP was performed and a plastic stent was inserted for biliary drainage. He has now returned for a repeat ERCP. The initial duodenoscopic view showed only one small opening which we thought would most likely represent the afferent limb. A more detailed sea.... view more....
Endoscopic and intraoperative laparoscopic demonstation of tatooing of colonic tumour
Marius Paraoan, MD : 11 Aug 2010
A 79 years old male patient was referred to our unit for laparoscopic resection of a small malignant right-sided colonic lesion identified during a previous colonoscopy. A repeat full colonoscopy with intubation of the terminal ileum was performed. During withdrawal phase a 2.5 centimetres non-polypoid lesion was identified at the level of the hepatic flexure. Under magnification the lesion has.... view more....
Marius Paraoan, MD : 11 Aug 2010
A 79 years old male patient was referred to our unit for laparoscopic resection of a small malignant right-sided colonic lesion identified during a previous colonoscopy. A repeat full colonoscopy with intubation of the terminal ileum was performed. During withdrawal phase a 2.5 centimetres non-polypoid lesion was identified at the level of the hepatic flexure. Under magnification the lesion has.... view more....
Peroral Pancreatoscopy: Removal of a Foreign Body from the Pancreatic Duct
Shahzad Iqbal, MD : 11 Aug 2010
A 65 years old gentleman who is status post transduodenal ampullectomy for tubular adenoma about three months ago, presented to us with on and off abdominal pain and elevated serum amylase and lipase levels. CT scan of the abdomen showed the pancreas to be unremarkable: however, a linear structure was noted inside the main pancreatic duct. Scout film of the abdomen showed a millimeter thick linear.... view more....
Shahzad Iqbal, MD : 11 Aug 2010
A 65 years old gentleman who is status post transduodenal ampullectomy for tubular adenoma about three months ago, presented to us with on and off abdominal pain and elevated serum amylase and lipase levels. CT scan of the abdomen showed the pancreas to be unremarkable: however, a linear structure was noted inside the main pancreatic duct. Scout film of the abdomen showed a millimeter thick linear.... view more....
VCE versus Colonoscopy for the Detection of Polyps and Cancer
Prakash Viswanathan, MD : 05 Jun 2010
Dr Prakash Viswanathan, Fellow at Stony Brook University Medical Center, presents journal club on the NEJM article published September 2009 titled "Capsule endoscopy versus colonoscopy for the detection of polyps and cancer"..... view more....
Prakash Viswanathan, MD : 05 Jun 2010
Dr Prakash Viswanathan, Fellow at Stony Brook University Medical Center, presents journal club on the NEJM article published September 2009 titled "Capsule endoscopy versus colonoscopy for the detection of polyps and cancer"..... view more....
Preoperative biliary drainage for cancer of the head of the pancreas
Leena Sayedy, MD : 05 Jun 2010
Dr Leena Sayedy, Fellow at Stony Brook University Medical Center, presents journal club on the NEJM article published in January 2010 titled "Preoperative biliary drainage for cancer of the head of the pancreas"..... view more....
Leena Sayedy, MD : 05 Jun 2010
Dr Leena Sayedy, Fellow at Stony Brook University Medical Center, presents journal club on the NEJM article published in January 2010 titled "Preoperative biliary drainage for cancer of the head of the pancreas"..... view more....
Neuroendocrine Tumors of the Gastrointestinal Tract
Vikram Deshpande, MD : 05 Jun 2010
Dr Vikram Deshpande, Assistant Professor of Pathology at Massachusetts General Hospital, reviews the pathology of GI neuroendocrine tumors. The presentation was recorded 25 May 2010..... view more....
Vikram Deshpande, MD : 05 Jun 2010
Dr Vikram Deshpande, Assistant Professor of Pathology at Massachusetts General Hospital, reviews the pathology of GI neuroendocrine tumors. The presentation was recorded 25 May 2010..... view more....
Cases from Bigelow Rounds
Esperance Schaefer, MD, MPH : 05 Jun 2010
Dr Esperance Shaefer, GI Fellow at Massachusetts General Hospital, presents selected clinical cases. The presentation was recorded 25 May 2010..... view more....
Esperance Schaefer, MD, MPH : 05 Jun 2010
Dr Esperance Shaefer, GI Fellow at Massachusetts General Hospital, presents selected clinical cases. The presentation was recorded 25 May 2010..... view more....
Esophageal stent for esophageal cancer following gastric bypass
Patrick Yachimski, MD : 02 Jun 2010
The patient is a 66 year old male referred for evaluation of dysphagia. His medical history is notable for obesity and longstanding gastroesophageal reflux disease. He had undergone laparoscopic Roux en Y gastric bypass and Nissen fundoplication 5 years prior. Endoscopy demonstrated an adenocarcinoma at the gastroesophageal junction, staged as a T3 lesion by radial echoendosonography. The hypo.... view more....
Patrick Yachimski, MD : 02 Jun 2010
The patient is a 66 year old male referred for evaluation of dysphagia. His medical history is notable for obesity and longstanding gastroesophageal reflux disease. He had undergone laparoscopic Roux en Y gastric bypass and Nissen fundoplication 5 years prior. Endoscopy demonstrated an adenocarcinoma at the gastroesophageal junction, staged as a T3 lesion by radial echoendosonography. The hypo.... view more....
EUS guided Choledochoduodenostomy
Kapil Gupta, M.D. : 02 Jun 2010
In this video we will describe a novel technique of EUS guided choledochoduodenostomy as a 1-step procedure using a echoendoscope. We perform this procedure in patients with unresectable malignancy causing obstructive jaundice. In patients where standard ERCP or EUS guided rendezvous has failed or is not an option. A detailed discussion with the family and the patient regarding the novel natur.... view more....
Kapil Gupta, M.D. : 02 Jun 2010
In this video we will describe a novel technique of EUS guided choledochoduodenostomy as a 1-step procedure using a echoendoscope. We perform this procedure in patients with unresectable malignancy causing obstructive jaundice. In patients where standard ERCP or EUS guided rendezvous has failed or is not an option. A detailed discussion with the family and the patient regarding the novel natur.... view more....
Ampullectomy: The use of methylene blue to aid in location of pancreatic orifice after ampullectomy
Bennett Hooks, MD : 01 Jun 2010
This 87-year-old female first presented to us with biliary obstruction 2 weeks after having aortic valve replacement. Plastic biliary stent was placed to relieve the obstruction and biopsies at the time revealed ampullary adenoma. Repeat ERCP with stent exchange and biopsies was performed confirming adenomatous tissue and EUS did not reveal any evidence of invasion of the adenoma. After multip.... view more....
Bennett Hooks, MD : 01 Jun 2010
This 87-year-old female first presented to us with biliary obstruction 2 weeks after having aortic valve replacement. Plastic biliary stent was placed to relieve the obstruction and biopsies at the time revealed ampullary adenoma. Repeat ERCP with stent exchange and biopsies was performed confirming adenomatous tissue and EUS did not reveal any evidence of invasion of the adenoma. After multip.... view more....
Pelvic organ prolapse: posterior compartment
Milena Weinstein, MD : 24 May 2010
Dr Milena Weinstein, urogynecologist in the Vincent Department of Obstetrics and Gynecology at Massachusetts General Hospital, delivered clinical grand rounds for the MGH GI unit on the topic of pelvic organ prolapse. The presentation was recorded 18 May 2010..... view more....
Milena Weinstein, MD : 24 May 2010
Dr Milena Weinstein, urogynecologist in the Vincent Department of Obstetrics and Gynecology at Massachusetts General Hospital, delivered clinical grand rounds for the MGH GI unit on the topic of pelvic organ prolapse. The presentation was recorded 18 May 2010..... view more....
Spiral Enteroscopy, Assisted Rendezvous ERCP
Satish Nagula, MD : 19 May 2010
This is a 61 year old female with a history of pancreatic CA, s/p pylorus preserving Whipple, chemotherapy and radiation 20 years prior. She clinically has no evidence of disease. She has a 2 yr history of recurrent attacks of severe abdominal pain. These attacks of pain were self-limited episodes that lasted several hours. She was ultimately admitted to our hospital with abdominal pain, fever.... view more....
Satish Nagula, MD : 19 May 2010
This is a 61 year old female with a history of pancreatic CA, s/p pylorus preserving Whipple, chemotherapy and radiation 20 years prior. She clinically has no evidence of disease. She has a 2 yr history of recurrent attacks of severe abdominal pain. These attacks of pain were self-limited episodes that lasted several hours. She was ultimately admitted to our hospital with abdominal pain, fever.... view more....
In Search of Novel Risk Determinants for Pancreatic Cancer
Brian M. Wolpin, MD : 19 May 2010
Dr Brian Wolpin, Instructor in Medcine at Harvard Medical School and Dana-Farber Cancer Institute, delivered clinical grand rounds at Massachusetts General Hospital GI Unit on 11 May 2010. The topic was risk markers for development of pancreatic cancer..... view more....
Brian M. Wolpin, MD : 19 May 2010
Dr Brian Wolpin, Instructor in Medcine at Harvard Medical School and Dana-Farber Cancer Institute, delivered clinical grand rounds at Massachusetts General Hospital GI Unit on 11 May 2010. The topic was risk markers for development of pancreatic cancer..... view more....
History of peptic ulcer disease and pancreatic cancer risk in men
Mark Wilkinson, MD : 19 May 2010
Dr Mark Wilkinson, GI Fellow at Stony Brook Medical Center, reviews the recent article from the journal Gastroenterology titled "History of peptic ulcer disease and pancreatic cancer risk in men". This journal club was recorded 28 April 2010..... view more....
Mark Wilkinson, MD : 19 May 2010
Dr Mark Wilkinson, GI Fellow at Stony Brook Medical Center, reviews the recent article from the journal Gastroenterology titled "History of peptic ulcer disease and pancreatic cancer risk in men". This journal club was recorded 28 April 2010..... view more....
Treatment with Monoclonal Antibodies Against Clostridium Difficile Toxins
Katherine Freeman, MD : 19 May 2010
Dr Katherine Freeman, GI Fellow at Stony Brook Medical Center, reviews the recent article from the New England Journal of Medicine titled "Treatment with Monoclonal Antibodies Against Clostridium Difficile Toxins". This journal club was recorded 28 April 2010..... view more....
Katherine Freeman, MD : 19 May 2010
Dr Katherine Freeman, GI Fellow at Stony Brook Medical Center, reviews the recent article from the New England Journal of Medicine titled "Treatment with Monoclonal Antibodies Against Clostridium Difficile Toxins". This journal club was recorded 28 April 2010..... view more....
EUS-guided transesophageal coiling and cyanoacrylate glue obliteration of gastric fundal varices
Kenneth F. Binmoeller, MD : 03 May 2010
Using a curved linear array echoendoscope, the gastric fundus can be imaged with the transducer positioned in the distal esophagus. Transesophageal access offers an alternative route to treat gastric fundal varices under EUS-guidance without entering the stomach. This anatomical cartoon illustrates transesohageal access to the gastric fundus from the distal esophagus. On radial EUS ima.... view more....
Kenneth F. Binmoeller, MD : 03 May 2010
Using a curved linear array echoendoscope, the gastric fundus can be imaged with the transducer positioned in the distal esophagus. Transesophageal access offers an alternative route to treat gastric fundal varices under EUS-guidance without entering the stomach. This anatomical cartoon illustrates transesohageal access to the gastric fundus from the distal esophagus. On radial EUS ima.... view more....
An unusual cause of dysphagia
Mankawal S. Sachdev, MD : 03 May 2010
This was a 30 year-old Caucasian-American male who had a past medical history that was significant for community acquired pneumonia and migraines. He presented to the clinic with a chief complaint of dysphagia for solids and weight loss. Chest x-rays both of the PA and lateral view were negative and without lymphadenopathy. A CT scan of the thorax was performed and was significant for the presence.... view more....
Mankawal S. Sachdev, MD : 03 May 2010
This was a 30 year-old Caucasian-American male who had a past medical history that was significant for community acquired pneumonia and migraines. He presented to the clinic with a chief complaint of dysphagia for solids and weight loss. Chest x-rays both of the PA and lateral view were negative and without lymphadenopathy. A CT scan of the thorax was performed and was significant for the presence.... view more....
Endoscopic management of iatrogenic peripancreatic abscess
Elie Aoun, MD : 03 May 2010
This video aims to demonstrate the EUS-assisted access to a peripancreatic abscess and subsequent drainage into the stomach in addition to the use of hydrogen peroxide to facilitate removal of necrotic debris. A 26 year old female patient presented with LUQ abdominal pain of two months duration. Her past medical history was significant for obesity, endometriosis and a cholecystectomy. A CT s.... view more....
Elie Aoun, MD : 03 May 2010
This video aims to demonstrate the EUS-assisted access to a peripancreatic abscess and subsequent drainage into the stomach in addition to the use of hydrogen peroxide to facilitate removal of necrotic debris. A 26 year old female patient presented with LUQ abdominal pain of two months duration. Her past medical history was significant for obesity, endometriosis and a cholecystectomy. A CT s.... view more....
Experience with a prototype forward-viewing curvilinear array therapeutic echoendoscope for interventional EUS: A case series
Michael K Sanders, MD : 03 May 2010
Experience with a prototype forward-viewing curvilinear array therapeutic echoendoscope for interventional EUS: a case series. Interventional EUS offers a minimally invasive alternative to traditional surgical and/or radiologic interventions for the treatment of pancreaticobiliary disorders. These procedures are typically performed with oblique-viewing instruments. However, standard oblique.... view more....
Michael K Sanders, MD : 03 May 2010
Experience with a prototype forward-viewing curvilinear array therapeutic echoendoscope for interventional EUS: a case series. Interventional EUS offers a minimally invasive alternative to traditional surgical and/or radiologic interventions for the treatment of pancreaticobiliary disorders. These procedures are typically performed with oblique-viewing instruments. However, standard oblique.... view more....
EUS guided confocal laser endomicroscopy of the pancreas
Harry Aslanian, M.D. : 03 May 2010
EUS guided probe confocal laser endomicroscopy (abbreviated pCLE) is performed in a feasibility study of three pancreas lesions, including a neuroendocrine tumor, adenocarcinoma and a solid-pseudopapillary neoplasm. 2.5 ml of 10% fluorescein was given intravenously as a contrast agent for pCLE imaging. The confocal probe was passed through a 19 G needle under EUS guidance in an HIC approved p.... view more....
Harry Aslanian, M.D. : 03 May 2010
EUS guided probe confocal laser endomicroscopy (abbreviated pCLE) is performed in a feasibility study of three pancreas lesions, including a neuroendocrine tumor, adenocarcinoma and a solid-pseudopapillary neoplasm. 2.5 ml of 10% fluorescein was given intravenously as a contrast agent for pCLE imaging. The confocal probe was passed through a 19 G needle under EUS guidance in an HIC approved p.... view more....
Endoscopic submucosal dissection of a giant rectal adenoma using a Flush-knife
Dimitri Coumaros, MD : 03 May 2010
We report the case of an endoscopic submucosal dissection of a granular type adenoma spreading over eight tenths of the rectum, and sparing a healthy strip of the posterior rectal aspect, in a 75-year-old man, using an electrosurgical endo-knife with a water-jet function, the Flush-knife.. Here we can see through both a direct and retroflex view this almost circumferential lesion. Here this heal.... view more....
Dimitri Coumaros, MD : 03 May 2010
We report the case of an endoscopic submucosal dissection of a granular type adenoma spreading over eight tenths of the rectum, and sparing a healthy strip of the posterior rectal aspect, in a 75-year-old man, using an electrosurgical endo-knife with a water-jet function, the Flush-knife.. Here we can see through both a direct and retroflex view this almost circumferential lesion. Here this heal.... view more....
Endoscopic rendezvous for complete colonic obstruction
Evan B. Grossman, MD : 03 May 2010
A 50 year old man has a past medical history of bilateral congenital glaucoma causing him to be legally blind and metastatic rectal cancer to the liver. The patient's cancer was diagnosed because he had developed rectal obstruction. As a result, he underwent a diverting transverse loop colostomy. The patient had difficulty managing his ostomy because of his blindness. He requested resectio.... view more....
Evan B. Grossman, MD : 03 May 2010
A 50 year old man has a past medical history of bilateral congenital glaucoma causing him to be legally blind and metastatic rectal cancer to the liver. The patient's cancer was diagnosed because he had developed rectal obstruction. As a result, he underwent a diverting transverse loop colostomy. The patient had difficulty managing his ostomy because of his blindness. He requested resectio.... view more....
Harnessing the power of magnets: Novel uses in advanced endoscopic therapies
Marvin Ryou, MD : 03 May 2010
Background/ Case: Magnets have previously been shown to be useful in endoscopic foreign body removal, EMR, and also in a NOTES surgical/navigation system. Endoscopic Methods: Thre endoscopic applications are presented that feature the novel use of rare-earth magnets. (1) NOTES magnetic retraction using and external magnet interacting with smaller endoscopically delivered magnets affixed t.... view more....
Marvin Ryou, MD : 03 May 2010
Background/ Case: Magnets have previously been shown to be useful in endoscopic foreign body removal, EMR, and also in a NOTES surgical/navigation system. Endoscopic Methods: Thre endoscopic applications are presented that feature the novel use of rare-earth magnets. (1) NOTES magnetic retraction using and external magnet interacting with smaller endoscopically delivered magnets affixed t.... view more....
Endoscopic management of an infected pseudocyst with cystgastrostomy and necrosectomy without EUS guidance
Vinay Chandrasekhara, M.D. : 03 May 2010
The treatment of pancreatic pseudocysts has historically been managed by surgeons; however, endoscopic drainage of pancreatic pseudocysts by expert endoscopists has become an accepted alternative to surgery when an intervention is indicated. Its advantage over percutaneous drainage is the ability to place multiple internal drains with minimal patient discomfort through one puncture site and the av.... view more....
Vinay Chandrasekhara, M.D. : 03 May 2010
The treatment of pancreatic pseudocysts has historically been managed by surgeons; however, endoscopic drainage of pancreatic pseudocysts by expert endoscopists has become an accepted alternative to surgery when an intervention is indicated. Its advantage over percutaneous drainage is the ability to place multiple internal drains with minimal patient discomfort through one puncture site and the av.... view more....
Image guided technology in endoscopy
Keith L. Obstein, MD : 03 May 2010
Consider the benefits of looking inside the human body during an interventional procedure and seeing in real-time all anatomic structures in precise three-dimensional detail. This is what Image Guided Intervention technology provides its users. Image guided technologies allow for integration of imaging modalities and interventional procedures. Image guidance has been utilized in the fields.... view more....
Keith L. Obstein, MD : 03 May 2010
Consider the benefits of looking inside the human body during an interventional procedure and seeing in real-time all anatomic structures in precise three-dimensional detail. This is what Image Guided Intervention technology provides its users. Image guided technologies allow for integration of imaging modalities and interventional procedures. Image guidance has been utilized in the fields.... view more....
New techniques in gastrointestinal hemostasis
Sohail N. Shaikh, MD : 03 May 2010
Gastrointestinal bleeding is an ominous complication associated with 5-10% mortality. Various methods have been developed for endoscopic control. (pause) Clips, cautery, APC, and injection therapy have been useful with good efficacy. Using principles established by these tools future devices may better address current limitations by enhancing tissue capture and providing greater compressive.... view more....
Sohail N. Shaikh, MD : 03 May 2010
Gastrointestinal bleeding is an ominous complication associated with 5-10% mortality. Various methods have been developed for endoscopic control. (pause) Clips, cautery, APC, and injection therapy have been useful with good efficacy. Using principles established by these tools future devices may better address current limitations by enhancing tissue capture and providing greater compressive.... view more....
Fiber optic intraductal endoscopy using standard ERCP catheters; initial video experience
Douglas A. Howell, M.D. : 03 May 2010
Fiber optic and video baby-scopes have been available for many years; however limitations have included fragility, use in ducts less than 10Fr in size, high cost and time spent. This study is to look at a recently introduced reusable fiber optic bundle which will fit through standard ERCP accessories. We wish to examine smaller ducts and see if these techniques could save costs and save time..... view more....
Douglas A. Howell, M.D. : 03 May 2010
Fiber optic and video baby-scopes have been available for many years; however limitations have included fragility, use in ducts less than 10Fr in size, high cost and time spent. This study is to look at a recently introduced reusable fiber optic bundle which will fit through standard ERCP accessories. We wish to examine smaller ducts and see if these techniques could save costs and save time..... view more....
Double balloon ERCP and choledochoscopy for the treatment of choledochocele following gastric bypass
Juan Carlos Bucobo, M.D. : 03 May 2010
Increased prevalence of morbid obesity has resulted in an increased frequency of Roux-en-Y gastric bypass. Investigation of pancreatic and biliary complaints following roux-Y gastric bypass is difficult secondary to rerouting of the small bowel, a long intestinal limb and limited access to the major papilla; previously only achieved by surgical or percutaneous methods. Double balloon ente.... view more....
Juan Carlos Bucobo, M.D. : 03 May 2010
Increased prevalence of morbid obesity has resulted in an increased frequency of Roux-en-Y gastric bypass. Investigation of pancreatic and biliary complaints following roux-Y gastric bypass is difficult secondary to rerouting of the small bowel, a long intestinal limb and limited access to the major papilla; previously only achieved by surgical or percutaneous methods. Double balloon ente.... view more....
Enteroscope-assisted large bile duct stone removal using a papillary large balloon in patients with roux-en-y anastomosis
Takao Itoi, MD, PhD : 03 May 2010
ERCP in patients with surgically altered anatomy, in particular Roux-en-Y anastomosis, can be more challenging. The use of balloon overtube-assisted enteroscopy can be useful for ERCP in patients with such surgically altered anatomy. Even using an enteroscope, removing large or multiple stones can be often difficult and time-consuming. Several endoscopists have reported that papillary large ball.... view more....
Takao Itoi, MD, PhD : 03 May 2010
ERCP in patients with surgically altered anatomy, in particular Roux-en-Y anastomosis, can be more challenging. The use of balloon overtube-assisted enteroscopy can be useful for ERCP in patients with such surgically altered anatomy. Even using an enteroscope, removing large or multiple stones can be often difficult and time-consuming. Several endoscopists have reported that papillary large ball.... view more....
Endoscopic Management of pancreaticojejunostomy strictures
Brett J. Partridge, MD : 03 May 2010
The pancreaticoduodenectomy, better known as the Whipple procedure, is performed for both benign and malignant indications. These include resectable pancreatic adenocarcinoma, mucinous neoplasms and neuroendocrine tumors. Long-term survival varies from 5-80%, largely based on the underlying indication for surgery. In a therapeutic endoscopy practice at a cancer center, we are referred patients.... view more....
Brett J. Partridge, MD : 03 May 2010
The pancreaticoduodenectomy, better known as the Whipple procedure, is performed for both benign and malignant indications. These include resectable pancreatic adenocarcinoma, mucinous neoplasms and neuroendocrine tumors. Long-term survival varies from 5-80%, largely based on the underlying indication for surgery. In a therapeutic endoscopy practice at a cancer center, we are referred patients.... view more....
Peroral transhepatic cholangioscopy and lithotripsy after biliopancreatic diversion
Manuel Perez-Miranda, MD : 03 May 2010
Biliopancreatic diversion is a morbid obesity surgery in which a long afferent loop is anastomosed to the ileum. It makes peroral ERCP impossible. Intraoperative ERCP through the distal antrum is feasible, and convenient if cholecystectomy is needed. A 72 y.o. female had prior cholecystectomy and biliopancreatic diversion with gastrectomy. She was offered a three step endoscopic approach for CB.... view more....
Manuel Perez-Miranda, MD : 03 May 2010
Biliopancreatic diversion is a morbid obesity surgery in which a long afferent loop is anastomosed to the ileum. It makes peroral ERCP impossible. Intraoperative ERCP through the distal antrum is feasible, and convenient if cholecystectomy is needed. A 72 y.o. female had prior cholecystectomy and biliopancreatic diversion with gastrectomy. She was offered a three step endoscopic approach for CB.... view more....
Gallstone Ileus: Endoscopic Management
Haritha Avula, MD : 03 May 2010
Our patient is a 55 year old woman presenting with intermittent episodes of periumbilical abdominal pain and nausea of 2 months duration. She had extensive prior history of abdominal surgeries including ovarian cancer resection complicated by colonic perforation. This was treated with segmental colonic resection and temporizing ileostomy. Subsequently ileostomy take down and ileo-ileal anastamos.... view more....
Haritha Avula, MD : 03 May 2010
Our patient is a 55 year old woman presenting with intermittent episodes of periumbilical abdominal pain and nausea of 2 months duration. She had extensive prior history of abdominal surgeries including ovarian cancer resection complicated by colonic perforation. This was treated with segmental colonic resection and temporizing ileostomy. Subsequently ileostomy take down and ileo-ileal anastamos.... view more....
From bypass to thruway: Endoscopic creation of a gastro-gastric conduit for reversal of gastric bypass
Mihir S. Wagh, MD : 03 May 2010
Introduction A 44 year old female with a past history of Roux-en-Y gastric bypass underwent an emergent antrectomy for a perforated peptic ulcer. This resulted in a completely excluded remnant stomach which required a permanent surgical gastrostomy tube for drainage of secretions. This figure shows the anatomy after Roux-en-Y gastric bypass. The patient then underwent an emergency antrectomy th.... view more....
Mihir S. Wagh, MD : 03 May 2010
Introduction A 44 year old female with a past history of Roux-en-Y gastric bypass underwent an emergent antrectomy for a perforated peptic ulcer. This resulted in a completely excluded remnant stomach which required a permanent surgical gastrostomy tube for drainage of secretions. This figure shows the anatomy after Roux-en-Y gastric bypass. The patient then underwent an emergency antrectomy th.... view more....
''Tulip bundle technique'' a novel technique for closing perforations caused by endoscopic resection, by placement of clips and approximation with endoloops
Roos E. Pouw, MD : 03 May 2010
The first case shows a 61-year old man with a flat-type adenoma in the bulbus, with low-grade dysplasia in biopsies. The lesion was removed using the multi-band mucosectomy technique. The first resection, however, resulted in an 8-mm large perforation. Here you see the flat type lesions in the bulbus and the luminal defect immediately after endoscopic resection. Since the defect was too large to.... view more....
Roos E. Pouw, MD : 03 May 2010
The first case shows a 61-year old man with a flat-type adenoma in the bulbus, with low-grade dysplasia in biopsies. The lesion was removed using the multi-band mucosectomy technique. The first resection, however, resulted in an 8-mm large perforation. Here you see the flat type lesions in the bulbus and the luminal defect immediately after endoscopic resection. Since the defect was too large to.... view more....
Endoscopic myotomy for the treatment of achalasia
Stavros N. Stavropoulos, M.D. : 03 May 2010
Laparoscopic Heller myotomy is recommended as primary treatment of achalasia in patients at low surgical risk. Problems have been reported with surgical myotomy that include gastroesophageal reflux disease in up to 8% of patients even with fundoplication. These patients are at risk of developing Barrett's esophagus and esophageal carcinoma. Mucosal perforation is also reported in a signifi.... view more....
Stavros N. Stavropoulos, M.D. : 03 May 2010
Laparoscopic Heller myotomy is recommended as primary treatment of achalasia in patients at low surgical risk. Problems have been reported with surgical myotomy that include gastroesophageal reflux disease in up to 8% of patients even with fundoplication. These patients are at risk of developing Barrett's esophagus and esophageal carcinoma. Mucosal perforation is also reported in a signifi.... view more....
Gastric endoscopic submucosal dissection (ESD) with a new traction method: the Clip-band technique
Adolfo Parra-Bianco, MD, PhD : 03 May 2010
ESD is a technique for the resection of early gastrointestinal neoplasia, whose main advantage is that lesion without almost any size limit can be resected. However, it is technically challenging and associated with a significant risk of perforation. Submucosal dissection, after having completed the circumferential incision, is the most difficult stage, because of limited visibility of the dissect.... view more....
Adolfo Parra-Bianco, MD, PhD : 03 May 2010
ESD is a technique for the resection of early gastrointestinal neoplasia, whose main advantage is that lesion without almost any size limit can be resected. However, it is technically challenging and associated with a significant risk of perforation. Submucosal dissection, after having completed the circumferential incision, is the most difficult stage, because of limited visibility of the dissect.... view more....
Endoscopic Technique for the treatment of Pancreas Divisum
Shahzad Iqbal, MD : 17 Apr 2010
Pancreas divisum is a congenital abnormality that is seen in upto 7% of patients undergoing ERCP. It results from lack of fusion of ventral and dorsal pancreatic ducts. As shown in the MRCP images, the CBD and main PD do not join at major ampulla. This video will demonstrate the technique of endoscopic treatment of pancreas divisum. Ventral pancreatic duct is first cannulated via major papilla.... view more....
Shahzad Iqbal, MD : 17 Apr 2010
Pancreas divisum is a congenital abnormality that is seen in upto 7% of patients undergoing ERCP. It results from lack of fusion of ventral and dorsal pancreatic ducts. As shown in the MRCP images, the CBD and main PD do not join at major ampulla. This video will demonstrate the technique of endoscopic treatment of pancreas divisum. Ventral pancreatic duct is first cannulated via major papilla.... view more....
