MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'The Digital Atlas of Video Education - Gastroenterology' source. Tue, 16 Mar 2010 15:13:07 +0100 http://www.medworm.com/index.php?rid=3364630&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.verrucous.ca.vinnu.mpg.flv A 65 year old male presented with 1 yr history of dysphagia. An upper endoscopy showed white wart like appearing exudative lesions involving the mid and lower esophagus. The entire esophageal mucosa was friable. The appearance is more extensive in the lower esophagus with luminal narrowing but without any obstruction. Here you can see that the lesion extended through the GE junction into the gastric cardia. The biopsies from this lesion showed foci of hyperkeratosis and parakeratosis with moderate to severe atypia. This was suspicious for verrucous carcinoma. An endoscopic ultrasound performed using a radial echoendoscope showed thick circumferential hypoechoeic lesion arising from the mucosa and extending to the muscularis propria. Here one can appreciate the thickened submucosa up to ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3364630 Sun, 14 Mar 2010 16:03:49 +0100 3364630 http://www.medworm.com/index.php?rid=3363302&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fbuscaglia.T-G.fistula.mpg.flv A 49 year-old man underwent a recent esophagectomy for esophageal cancer. His postoperative course was complicated by a fistula between the trachea and the intra-thoracic stomach. A previously placed tracheal stent was unsuccessful at sealing the fistula. Using argon plasma coagulation, the perimeter of the opening is ablated in order to de-epithelialize the tissue and promote complete sealing of the fistula after approximating its edges. Endoscopic hemoclips are placed around the border of the fistula, and a detachable snare--or endoscopic polyloop--is used to approximate the edges of the defect. Following this, a flexible guidewire is placed within the intra-thoracic stomach. The endoscope is withdrawn, and the site of the fistula can be identified by the hemoclips. Under simultaneous ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3363302 Sat, 13 Mar 2010 14:03:02 +0100 3363302 http://www.medworm.com/index.php?rid=3195367&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.i.pol.pjs.pec.5.mpg.flv 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. A computer tomography of the abdomen and pelvis showed gastric polyps and dilated loops of bowel with obstruction from large polypoid lesions. A target sign was present. After the benefits and risks of surgery were explained to the patient, she elected endoscopy with double balloon enteroscopy with polypectomy to avoid surgery and maintain small bowel function. Both upper and lower endosc... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3195367 Thu, 21 Jan 2010 08:01:33 +0100 3195367 http://www.medworm.com/index.php?rid=3187031&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.d.div.obs.cli.nif.1oo.ke0508us.mpg.flv 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 the duodenal lumen. The endoscopic appearance is consistent with a windsock diverticulum. This intraluminal diverticulum is thought to result from incomplete recanalization of the duodenum during embryological development and with complete obstruction, symptoms present during childhood. In contrast, when there is a small aperture in the duodenum, patients may initially remain asymptomatic. Howeve... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3187031 Tue, 19 Jan 2010 09:01:09 +0100 3187031 http://www.medworm.com/index.php?rid=3165266&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.i.apx.oo.oo.eus.0903bu.mpg.flv 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 correspond to the submucosal layer; thus making this polyp a superficial, mucosal-based lesion. The polyp is then grasped with a standard biopsy forceps in order to expose all points of involvement within the appendiceal lumen for complete inspection. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3165266 Wed, 13 Jan 2010 11:01:52 +0100 3165266 http://www.medworm.com/index.php?rid=3064636&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.can.guide.wire.pa0912us.mpg.flv 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 septum in the direction of the bile duct. Loop-tip guidewire is a 0.035 inch guide wire with an atraumatic tip . The loop at end prevents dissection of the tissue and prevents puncturing of pancreatic duct. The radio-opacity of the guide wire tells us the duct accessed without injecting contrast. Also, the guide wire has enough stiffness for adequate pushing force. This schematic diagram shows how ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3064636 Tue, 08 Dec 2009 10:12:08 +0100 3064636 http://www.medworm.com/index.php?rid=3014033&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.bal.dil.stn.pa0911.mpg.flv 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 bile duct and the cholangiogram was obtained. Here we see a large common bile duct stone on the cholangiogram. This stone was approximately 15 mm in size. A small biliary sphincterotomy was performed using the endocut current. We used controlled radial expansion (CRE) balloon over the guidewire to dilate the biliary orifice. We inflated the CRE balloon up to 12 mm and was kept in position for appro... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3014033 Fri, 20 Nov 2009 16:11:33 +0100 3014033 http://www.medworm.com/index.php?rid=3183575&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.eus.fna.mas.sto0911.mpg.flv 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 investigate this polyp the patient had a CT abdomen that did not show the polyp but that revealed a 1.6 cm well defined mass in the neck of the pancreas (figure 1,2). On EUS a well defined 1.6 cm homogenous hypoechoic mass with a central calcification was seen in the neck of the pancreas. The pancreatic duct was mildly dilated in the body and tail. There were no enlarged lymph nodes and the live... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3183575 Fri, 20 Nov 2009 15:11:39 +0100 3183575 http://www.medworm.com/index.php?rid=3183576&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.es.stent.bu0910.mpg.flv 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 pancreatic duct stent. Using a guidewire technique, the sphincterotome cutting wire is positioned in the 12 o'clock to 1 o'clock position to cut the pancreatic portion of the sphincter of Oddi. In order to expose more of the intraduodenal portion of the sphincter muscle, the sphincterotome is contracted, or bowed, within the proximal pancreatic duct while simultaneously withdrawing the instrument ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=3183576 Fri, 20 Nov 2009 15:11:16 +0100 3183576 http://www.medworm.com/index.php?rid=2972543&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.eus.0910bu.mpg.flv 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 bladder. Upon pull-through with the EUS scope, the rectal wall is identified showing the muscularis propria and a thickened submucosal space suggesting tumor involvement. The tumor appears to extend through the muscularis propria, shown here at the 6 o'clock position. As the probe is withdrawn further, there is easy identification of the seminal vesicles. Upon withdrawal of the EUS scope towards the... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2972543 Mon, 09 Nov 2009 11:11:57 +0100 2972543 http://www.medworm.com/index.php?rid=2932539&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fbadihe_endoscopic-necrosectomy.mpg.flv 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 supplementation and pancreatic enzyme replacement. Abdominal computed tomography (CT) scan revealed a 15 cm x 5 cm collection of necrotic debris and gas replacing the majority of the pancreatic parenchyma. A prolonged trial of percutaneous drainage failed to resolve the collection and resulted in a pancreatic-percutaneous fistula. Because of the patient's multiple comorbidities, compromised nut... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2932539 Wed, 28 Oct 2009 10:10:48 +0100 2932539 http://www.medworm.com/index.php?rid=2932540&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fjaganmohan.band.lig.varic.ra200801f.mpg.flv 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 consisted of packed red blood cells, IV Octreotide, a proton pump inhibitor, antibiotics, fresh frozen plasma, vitamin K, Erythromycin. Emergent endoscopy was undertaken. As the scope enters the gastroesophageal junction, an actively spurting vessel is seen at 2 o'clock on the screen in the cardia. Here is the retroflexed view also showing bleeding from the cardia. After evaluation of the rest o... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2932540 Wed, 28 Oct 2009 10:10:12 +0100 2932540 http://www.medworm.com/index.php?rid=2910206&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.i.pig.ooo.ooo.bio.1op.br060613.mpg.flv 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, speckled pattern. There is no apparent associated mucosal thickening or other defects. Pseudomelanosis has been observed to occur anywhere along the length of the gastrointestinal tract. The pigment of pseudomelanosis has not been completely characterized although ferrous sulfide is commonly found on staining. A recent case series demonstrated that the majority of these patients are taking oral iron... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2910206 Wed, 21 Oct 2009 13:10:15 +0100 2910206 http://www.medworm.com/index.php?rid=2903729&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.pancCA.cpn.mpg.flv Author: Mohamad A. Eloubeidi, M.D., M.H.S., F.A.C.P., F.A.C.G. 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 We have a 62 year old lady with pancreatic cancer diagnosed two weeks ago. We started her on Loritab but unfortunately it did not help her pain. During last examination by EUS and by CT scan of abdomen there is clear evidence of involvement of the celiac artery and therefore she is not amenable for surgical evaluation and surgical resection. We counseled her regarding the... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2903729 Mon, 19 Oct 2009 13:14:13 +0100 2903729 http://www.medworm.com/index.php?rid=2717734&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.i.surg.stom.eja.med.manag.mpg.flv 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 gastrectomy for the management of gastric adenocarcinoma. The scope is introduced into the esophagus. One can see the esophago-jejunal anastomosis with the blind loop on the left and the patent loop on the right. Initial attempt was made to explore the blind loop followed by exploring the patent loop of jejunum. Here the endoscope is pushed through the patent loop followed by its withdrawal. ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2717734 Thu, 20 Aug 2009 07:08:47 +0100 2717734 http://www.medworm.com/index.php?rid=2717733&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.per.panc.necro.moyer.0908us.mpg.flv In conclusion, percutaneous endoscopic necrosectomy can be complementary to standard transluminal therapy in the management of complicated peri-pancreatic necrotic collections. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2717733 Thu, 20 Aug 2009 07:08:39 +0100 2717733 http://www.medworm.com/index.php?rid=2693348&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FPadda.rev.2009.07.08.mpg.flv 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 common bile duct with a markedly thickened wall and just below the bile duct is the portal vein. As the common bile duct is followed distally it becomes obstructed by the pancreatic head mass. The mass appeared hypechoic and irregular with measurements of approximately 4 cm x 3 cm. EUS guided fine needle aspiration of this mass proved it to be an adenocarcinoma. Here you see the sonographic imaging of t... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2693348 Wed, 12 Aug 2009 17:08:17 +0100 2693348 http://www.medworm.com/index.php?rid=2578228&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Freid_cgr_20090623.flv 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. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2578228 Wed, 08 Jul 2009 08:07:53 +0100 2578228 http://www.medworm.com/index.php?rid=2578229&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fsylla_cgr_20090519.flv 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. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2578229 Wed, 08 Jul 2009 07:07:13 +0100 2578229 http://www.medworm.com/index.php?rid=2578230&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.d.leak.roof.dasari.ra0907.mpg.flv 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 an ulcer in the first part of the duodenum. Biopsies taken from this ulcer were positive for H pylori infection. C. S. Goodwin published the Leaking roof concept explaining the pathogenesis of a DU in The Lancet in 1988. He compared the duodenum to a house with an intact roof. Any breech in the roof allows the leakage of acid rain resulting in the formation of an ulcer. We will now look in de... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2578230 Tue, 07 Jul 2009 09:07:56 +0100 2578230 http://www.medworm.com/index.php?rid=2578231&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_40_VTS_01_1.mpg.flv 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. ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2578231 Mon, 01 Jun 2009 06:06:56 +0100 2578231 http://www.medworm.com/index.php?rid=2578232&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_31_R2_Cholangioscopy.mpg.flv 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 electrohydraulic lithotripsy, or EHL. Traditional mother-daughter systems are limited by the need for two experienced endoscipists, poor visualization and the absence of a meaningful working channel. Single operator, fiberoptic cholangioscopy allows for four-way deflection and continuous irrigation, but the optical resolution remains inferior to standard endoscopic images. Direct, peroral chol... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2578232 Mon, 01 Jun 2009 06:06:55 +0100 2578232 http://www.medworm.com/index.php?rid=2578233&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_30_VTS_01_1.mpg.flv 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 position a pancreatogram was obtained which showed large stones occupying the pancreatic duct with a uniformly dilated duct. A sphincterotomy was then carried out of the pancreatic sphincter using a double lumen sphincterotome with the cut being carried some where between 12 to 2'oclock direction. The sphicterotomy was done in a step by step manner using a blended endocut current and as the cut... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2578233 Mon, 01 Jun 2009 06:06:54 +0100 2578233 http://www.medworm.com/index.php?rid=2516047&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_27_Costamagna.mpg.flv 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 persisted after 15 days. Patient was referred to our Endoscopy Unit for the endoscopic treatment. The severed duct stump was not identified in ERCP. Therefore, the cystic duct stump was cannulated and very stiff guide-wire was used to reopen the cystic duct stump. A diagnostic catheter was advanced and the stiff guide-wire was exchanged with a fully hydrophilic soft-angle-tip guide-wire. The ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2516047 Mon, 01 Jun 2009 06:06:53 +0100 2516047 http://www.medworm.com/index.php?rid=2516048&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_26_EUS_ERCP.mpg.flv 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 ERP. Therapeutic EUS techniques allow guidewire access into the pancreatic or bile duct in an anterograde fashion using EUS FNA. Once anterograde guidewire placement is achieved, pancreatic endotherapy is performed using standard ERCP techniques via a rendezvous procedure. This video will demonstrate anterograde access of the pancreatic duct using EUS FNA along with the ERP rendezvous procedu... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2516048 Mon, 01 Jun 2009 06:06:52 +0100 2516048 http://www.medworm.com/index.php?rid=2516049&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_15_IPMN.mpg.flv 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 abdominal pain, jaundice or weight loss. It is also associated with the highest malignant potential at approximately 40%. Typically the initial diagnosis is suspected on non-invasive imaging studies, and visualization and tissue sampling which may assist in operative planning by establishing the degree of dysplasia and extent of dysplasia. Narrow Band Imaging, or NBI, is a new technology that enh... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2516049 Mon, 01 Jun 2009 06:06:51 +0100 2516049 http://www.medworm.com/index.php?rid=2478593&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_12_Chattani.mpg.flv Conclusion: Cholangiosopy has finally come of age with the digital cholangioscopy with intraductal narrow band imaging and confocal microscopy enhancing biliary imaging and diagnosis. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2478593 Mon, 01 Jun 2009 06:06:50 +0100 2478593 http://www.medworm.com/index.php?rid=2478594&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_10_DDW-DoHyun.mpg.flv In conclusion, EUD with one-step placement of fully covered metal stent may be feasible, safe, and effective for an alternative to percutaneous transhepatic biliary drainage (PTBD) in case of malignant biliary obstruction when ERCP is unsuccessful. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2478594 Mon, 01 Jun 2009 06:06:49 +0100 2478594 http://www.medworm.com/index.php?rid=2478595&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_07_Pancreaticobiliary.mpg.flv We describe solutions, both old and new, for the following scenarios: 1. Solo navigation to the cannulation site using standard endoscopic equipment, such as pediatric colonoscop, shapelocking overtubes, and helical overtubes 2. Surgically assisted navigation to the cannulation site 3. Upon reaching the cannulation site, Failed cannuklation is more commonly encountered in altered anatomy and can be potentially addressed using perctuaneous and EUS-assisted rendezvous procedures We begin with solo navigation Solo navigation Simple manual pressure with a lead glove can be helpful For negotiating long jejunal limbs encountered in RY patients, and counteracting the loops that inevitably form. Alternatively, a pediatric colonoscope can be advanced to the papilla to deploy a guidewire over w... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2478595 Mon, 01 Jun 2009 06:06:48 +0100 2478595 http://www.medworm.com/index.php?rid=2465480&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FP_02_bullet.mpg.flv 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 foreign body appeared to the move after balloon dilation. Patient was referred for CT abdomen to evaluate the location of foreign body. It showed metallic artifact in the region of porta hepatis, limiting complete evaluation. Due to persistent abdominal pain elevated liver enzymes, patient was referred back for repeat ERCP with oral choledochoscopy. Movement of the foreign body was seen fluoroscopical... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2465480 Mon, 01 Jun 2009 06:06:47 +0100 2465480 http://www.medworm.com/index.php?rid=2465481&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FO_05_R2.mpg.flv We present the first case report of endoscopic gastroplasty using TOGA in the United States. The first stapler using vacuum pods to acquire tissue prior to closing and deploying a serosal –to serosal staple line. A restrictive stapler is passed to clamp gastric folds together within the pouch, decreasing the diameter of the pouch outlet. A 30 year old woman is referred for obesity treatment after failing diet and lifestyle modification. After informed consent, she agrees to undergo endoluminal gastroplasty. At the time of her procedure, her BMI was 48.2. After endotracheal or nasal intubation is performed under general anesthesia, a 60 French Savory dilation of the esophagus is performed. The flexible endoscope stapler is gently advanced into the body of the stomach. Once inserte... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2465481 Mon, 01 Jun 2009 06:06:46 +0100 2465481 http://www.medworm.com/index.php?rid=2465482&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FN_10_SB_resection.mpg.flv 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 laparoscopic Veress needle. Transvaginal port was established first. A flexible endoscope and an overtube was used to establish the transvaginal port. Colpotomy was performed through the posterior wall of the vagina by an endoscopic needle-knife. An endoscope with the overtube was advanced into the peritoneal cavity through the vaginal opening. The overtube was carefully advanced until its distal end was w... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2465482 Mon, 01 Jun 2009 06:06:45 +0100 2465482 http://www.medworm.com/index.php?rid=2717735&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FN_04_NOTES.mpg.flv 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 introducer system is introduced into the abdomen. One can see that this is simply and esophageal stent introducer. The Savary tip is pushed out and the inner tube is used to extrude the hernia mesh into the abdominal cavity (somewhat aseptically). The introducer is then removed and the endoscope is reinserted. The hernia mesh is about 10 x 10 or 10 x 12 cm piece of typical hernia mesh, and it has been... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2717735 Mon, 01 Jun 2009 06:06:44 +0100 2717735 http://www.medworm.com/index.php?rid=2717736&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FL_09_ASGE.mpg.flv In conclusion, this case illustrates the importance to recognize rare causes of gastrointestinal bleeding in patients post kidney-pancreas transplantation. Angiography may be a useful method of localizing sources of bleeding in the complex anatomy of post kidney-pancreas transplant patients. Endovascular stent placement may be a successful method for effective hemostasis from a communicating enteric to external iliac artery pseudoaneurysm. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2717736 Mon, 01 Jun 2009 06:06:43 +0100 2717736 http://www.medworm.com/index.php?rid=2717737&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FL_02_DDW.mpg.flv 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 attempts to completely fragment the stone. Again, progressive fragmentation is seen coring a hole through the middle of the stone. This view shows again a coring of the stone with a tunnel being developed within the midpoint of the stone. At this point attempts were made to extract the stone using a biliary occlusion balloon. The balloon was passed beyond the obstruction with the aid of a guidewire b... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2717737 Mon, 01 Jun 2009 06:06:42 +0100 2717737 http://www.medworm.com/index.php?rid=2717738&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2FS_04_spiralenterostent1.mpg.flv 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 placement. Using the spiral enteroscopy system, the enteroscope was advanced to the proximal mid-jejunum. There was evidence of tumor invasion of the small bowel at this level with a near complete obstruction of the bowel lumen. A sphincterotome, modified for use with the enteroscope, was advanced through the working channel. The sphincterotome was advanced beyond the luminal compromise. The ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2717738 Mon, 01 Jun 2009 06:06:40 +0100 2717738 http://www.medworm.com/index.php?rid=2407825&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.rec.ulc.ble.000.000.ha0905us.mpg.flv A 55 year old male recently discharged from the hospital after treatment for sepsis due to post-obstructive pneumonia related to lung cancer, and a DVT treated with Lovenox , developed hematochezia with passage of blood clots. Sigmoidoscopy at presentation revealed a large, nearly circumferential rectal ulcer, with islands of normal appearing intervening mucosa and no focal bleeding source seen. During his prior hospitalization he had a rectal tube placed after developing diarrhea and an ischemic ulcer was suspected. The patient developed recurrent hematochezia with the passage of clots and hypotension the next day. A repeat sigmoidoscopy revealed a spurting vessel within the rectal ulcer. Given the deep ulcer base and the degree of bleeding seen, a clip was placed directly on the vessel... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2407825 Wed, 13 May 2009 14:05:41 +0100 2407825 http://www.medworm.com/index.php?rid=2366208&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.e.slee.endo.loop.smt.o.0812us.mpg.flv Endoscopic treatment of a pedunculated submucosal tumor (SMT) has not been well developed. The unroofing technique involves snaring the pedunculated SMT at the middle of the mass and resecting only its upper half. However, this technique is applicable only in cases of lipomas and cystic lymphangiomas. An endoscopic cautery snare resection of a large SMT is not recommended because of the risk of bowel perforation. Because of muscular colonic contractions, there was repeated extrusion of the submucosal mass into the lumen of the bowels, which caused the formation of a pseudopedicle. With extremely large lesions, a pseudopedicle may form a serosal invagination; therefore, it may contain the deeper muscular layer of the colonic wall and increase the risk of bowel perforation. The endoloop,... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2366208 Sat, 25 Apr 2009 16:04:03 +0100 2366208 http://www.medworm.com/index.php?rid=2366209&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.cys.pse.stn.000.0902co.mpg.flv This is a case of a 40 year old male with chronic, relapsing pancreatitis secondary to alcohol use, who was referred for endoscopic pseudocyst drainage. Following a flare of pancreatitis, the patient experienced persistent post-prandial abdominal pain, nausea and early satiety. A CT scan demonstrated interval development of a large, homogeneous pseudocyst in the head of the pancreas with partial obstruction of the duodenum. Endoscopy was performed with a side-viewing duodenoscope and revealed extrinsic compression of the duodenal bulb. A sclerotherapy needle was used to puncture the duodenum at the site of maximal compression and injection of contrast confirms communication with the large cystic cavity. A needle-knife papillotome was then used to incise the duodenal and pseudocyst walls... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2366209 Sat, 25 Apr 2009 15:04:55 +0100 2366209 http://www.medworm.com/index.php?rid=2360371&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.fna.ble.0r0.000.0810br.mpg.flv This is a healthy 40 year-old engineer from another country who underwent a screening ultrasound and a cystic lesion was seen in the head of the pancreas. It was confirmed with a cat scan. Linear endoscopic ultrasound was used to examine the lesion in the head of the pancreas and a mixed micro and macro cystic lesion consistent with an IPMN or a serous cystadenoma was seen in the head of the pancreas. A 22 gauge needle was used to perform fine needle aspiration. The largest cavity was readily entered with a needle and clear non-viscous fluid was readily obtained from the cyst Immediately following the fine needle aspiration, bleeding was seen to have occurred at the site of the fine needle aspiration. Color Doppler readily identifies the bleeding and the flow of blood within the cyst cavi... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2360371 Thu, 23 Apr 2009 10:04:53 +0100 2360371 http://www.medworm.com/index.php?rid=2360372&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.cho.cyst.ooo.freeman.mpg.flv This 17 year old male was referred for unexplained acute pancreatitis. His initial episode of acute pancreatitis resulted in a 5 day hospitalization, with serum lipase 10 times normal, and CT showing mild interstitial pancreatitis. He has had intermittent mild abdominal pain since. Laparoscopic cholecystectomy was performed because of a dilated gallbladder; intraoperative cholangiogram showed dilation of the terminal bile duct. ERCP attempted locally resulted in inability to find any orifice or cannulate any duct in the major papilla. He was referred to us for further evaluation. MRCP with secretin was performed. With successive images after secretin injection, you can see cystic dilation of terminal bile duct and pancreatic duct, which appear to be separate and parallel, then fuse into o... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2360372 Thu, 23 Apr 2009 10:04:08 +0100 2360372 http://www.medworm.com/index.php?rid=2357983&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fchung_cgr_20090324.flv Dr. Daniel Chung, Clinical Director, Gastrointestinal Cancer Genetics Program at Massachusetts General Hospital and Assistant Professor of Medicine at Harvard Medical School, delivered clinical grand rounds at the MGH GI unit on the topic of hereditary colon cancer. Topics included Familial adenomatous polyposis (FAP), MYH-associated polyposis (MAP), Lynch syndrome. This presentation was recorded 24 March 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2357983 Tue, 21 Apr 2009 13:04:56 +0100 2357983 http://www.medworm.com/index.php?rid=2355031&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fchung_cgr_20090324.flv Dr. Daniel Chung, Clinical Director, Gastrointestinal Cancer Genetics Program at Massachusetts General Hospital and Assistant Professor of Medicine at Harvard Medical School, delivered clinical grand rounds at the MGH GI unit on the topic of hereditary colon cancer. Topics included Familial adenomatous polyposis (FAP), MYH-associated polyposis (MAP), Lynch syndrome. This presentation was recorded 24 March 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2355031 Tue, 21 Apr 2009 13:04:56 +0100 2355031 http://www.medworm.com/index.php?rid=2355033&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fgordon_cgr_20090331.flv Dr Fredric Gordon, Medical Director of Liver Transplantation and Director of Hepatology at Lahey Clinic, delivered clinical grand rounds at the Massachusetts General Hospital GI Unit. The topic was "Hepatitis C After Liver Transplantation". The presentation was recorded 31 March 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2355033 Tue, 21 Apr 2009 13:04:55 +0100 2355033 http://www.medworm.com/index.php?rid=2309158&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fkhalili_cfc_20090304.flv Dr Hamed Khalili, Gi Fellow at Massachusetts General Hospital, presents Bigelow Rounds at the MGH GI Unit. The first case presented involves a 40 year old female with hepatitis C, who presents with numbness and tingling in her extremities and develops a rash. The second case involves a 76 year old man admitted for evaluation of suprapubic abdominal pain found to be anemia with guaiac positive stool. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2309158 Tue, 31 Mar 2009 11:03:07 +0100 2309158 http://www.medworm.com/index.php?rid=2309160&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Ffriedman_cgr_20090217.flv Dr Lawrence Friedman, Chair of the Department of Medicine at Newton-Wellesley Hospital and Professor of Medicine at Harvard Medical School and Tufts University School of Medicine, presents Clinical Grand Rounds at MGH GI Unit on the topic of surgery in patients with liver disease. The presentation was recorded Feb. 17, 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2309160 Sun, 29 Mar 2009 15:03:59 +0100 2309160 http://www.medworm.com/index.php?rid=2309162&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fpratt_cfc_20090317.flv Dr. Daniel Pratt, Assistant Professor of Medicine at Harvard Medical School, presented fellows' case conferences at the MGH GI Unit on the topic of hepatitis. The presentation was recorded on March 17, 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2309162 Fri, 27 Mar 2009 08:03:05 +0100 2309162 http://www.medworm.com/index.php?rid=2288453&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.gist.000.000.yal.0902as.mpg.flv CT scan performed to evaluate pneumonia in a 75 year old female identified a large gastric mass. The patient had no upper intestinal symptoms. EGD revealed a large, smooth, rounded mass occupying most of the fundus with a mosaic appearance of the overlying mucosa. The mass was arising from the fundus, noted to be at the same location as an 8 mm intramural nodule (arrow) seen on EGD performed 7 years prior, to evaluate anemia. Linear EUS revealed a 68 x 69 mm hypoechoic mass arising from the muscularis propria with a central anechoic area within the lesion. EUS guided fine needle aspiration (FNA) confirmed a spindle cell neoplasm. The patient underwent a partial gastrectomy which showed a 10 x 9 x 7 cm gastric mass. Pathology revealed malignant spindle cells and moderate nuclear pleomorp... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2288453 Wed, 25 Mar 2009 13:03:57 +0100 2288453 http://www.medworm.com/index.php?rid=2288455&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.d.car.pat.000.000.0902br.mpg.flv Duodenum - carcinoid tumor, with EUS FNA This is a 54 yo female with known chronic liver disease who underwent upper GI endoscopy and a small carcinoid lesion was found in the duodenum. On this examination we see a smooth, round, superficial, subepithelial lesion with some central dimpling. The findings are consistent with a neuroendocrine tumor of the duodenal bulb. Endoscopic ultrasound was used to examine the area, and to our surprise we found a 1.9 cm lesion within the head of the pancreas. The ultrasound characteristics of the lesion, smooth, round, homogeneous, and isoechoic, are essentially diagnostic of a neuroendocrine tumor. The lesion appeared to be separate from the duodenal wall lesion, and on magnified views on ultrasound we can see that it is contained within the head of... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2288455 Wed, 25 Mar 2009 13:03:23 +0100 2288455 http://www.medworm.com/index.php?rid=2288454&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.car.aue.d.pat.000.0902br.mpg.flv This is a 77 year old male who presents with occult gastrointestinal bleeding and anemia. The upper GI endoscopy demonstrates a focal friable mass in the proximal stomach. Retroflexed views of the stomach reveal a generally atrophic mucosa without evidence of additional lesions. Close-up view of the mass reveals that it is friable and firm, but easily biopsied. High-frequency ultrasound is performed of the lesion using water in the stomach as the medium. The high-frequency probe is placed directly adjacent to the mass lesion to determine the depth of penetration. We can see a focal, hypoechoic, infiltration just below the mucosa. It infiltrates into the submucosa, but there is no involvement of the muscularis propria. Biopsies demonstrate nests of small cells consistent with a carcino... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2288454 Wed, 25 Mar 2009 13:03:19 +0100 2288454 http://www.medworm.com/index.php?rid=2288458&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fbasgoz_cgr_20090224.flv Dr. Nesli Basgoz, Associate Chief of the Division of Infectious Diseases at the MGH and Associate Professor of Medicine at Harvard Medical School, presented Clinical Grand Rounds at the MGH GI Unit. The presentation concerns principles of opportunistic infections in HIV, cases of OIs, and Immune Reconstitution Inflammatory Syndrome. The presentation was recorded Feb 24, 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2288458 Tue, 24 Mar 2009 11:03:43 +0100 2288458 http://www.medworm.com/index.php?rid=2288456&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fdayyeh_cfc_20090303.flv Dr. Barham Abu Deyyah, GI Fellow at Massachusetts General Hospital, presents Bigelow Rounds on the case of a 59 year old female with cryptogenic child C cirrhosis complicated by refractory ascites and encephalopathy undergoing work-up for OLT, presented with worsening encephalopathy, pain over the right side of her tongue preventing her from eating, and dyspnea on exertion. This presentation was recorded March 3, 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2288456 Tue, 24 Mar 2009 08:03:19 +0100 2288456 http://www.medworm.com/index.php?rid=2288459&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fmacnaughtan_cjc_20090223.flv Dr. J Macnaughtan presents journal club at St. Mark's Hospital, London, on the recent article in Gastroenterology titled "Infliximab prevents Crohn's Disease Recurrence After Ileal Resection". This presentation was recorded February 23, 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2288459 Mon, 23 Mar 2009 11:03:55 +0100 2288459 http://www.medworm.com/index.php?rid=2288460&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fmacnaughtan_cjc_2_20090223.flv Dr. J Macnaughten presents journal club at St. Mark's Hospital, London on the recent article in Gastroenterology titled "Therapy of Metronidazole with Azathioprine to prevent postoperative recurrence of Crohn's Disease: A Controlled Randomized Trial". This presentation was recorded Feb 23, 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2288460 Mon, 23 Mar 2009 11:03:15 +0100 2288460 http://www.medworm.com/index.php?rid=2277403&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fchung_cfc_20090224.flv Dr Daniel C. Chung, Director of GI Cancer Genetics Service at Massachusetts General Hospital, presents an update on the state of colorectal cancer screening. The presentation was recorded on March 3, 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2277403 Tue, 17 Mar 2009 06:03:17 +0100 2277403 http://www.medworm.com/index.php?rid=2232710&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.e.eus.ooo.ooo.padda.0812us.mpg.flv This is a 77 year old male who complained of progressive dysphagia to solids and liquids after unimpressive EGD 3 months ago for coffee ground emesis. He had a remote history of neck irradiation for neck tumor 40 years ago. Endoscopic examination of his larynx revealed multiple telangiectasia suggestive of prior radiation exposure. The arytenoid folds were swollen, most likely due to lymphatic blockage. At the esophageal introitus, there was circumferential verrucous and friable mucosa. We obtained extensive biopsies of this abnormal tissue. An ERCP wire guide and catheter was used to cannulate the esophageal lumen under fluoroscopy. After confirming with contrast injection we dilated the stricture with a 15 mm through the scope endoscopic balloon. The verrucous tissue extended 2 cm below... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2232710 Tue, 03 Mar 2009 13:03:53 +0100 2232710 http://www.medworm.com/index.php?rid=2232711&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.hia.her.ooo.utmb.0812us.mpg.flv Hiatal Hernia is defined as herniation of a portion of the stomach through the diaphragmatic esophageal hiatus. Hiatal hernias are classified into sliding, paraesophageal and mixed types. This diagram illustrates the normal anatomy of the Gastro-esophageal (GE) junction. Notice the position of the lower esophageal sphincter (LES) which lies below the diaphragmatic crura. This relationship is altered in a sliding hiatal hernia with the LES lying above the diaphragmatic crura. Fluoroscopy further illustrates this altered anatomy with the GE junction lying above the level of the diaphragm. This video demonstrates a sliding hiatal hernia. Note the converging gastric folds around the scope which mark the position of the LES. The level of the diaphragm is indicated by the impression on the st... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2232711 Tue, 03 Mar 2009 13:03:44 +0100 2232711 http://www.medworm.com/index.php?rid=2216636&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fkuo_cgr_20090210.flv Dr. Braden Kuo, Instructor in Medicine at Harvard Medical School, presents Clinical Grand Rounds at the MGH GI Unit concerning using the SmartPill for inspection of gastric, small bowel, and colon issues. The presentation was recorded on 10 February 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2216636 Wed, 25 Feb 2009 14:02:25 +0100 2216636 http://www.medworm.com/index.php?rid=2182621&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fgupta_cjc_2_200901xx.flv Dr. Sachin Gupta, Endoscopy Research Fellow at St. Mark's Hospital, London, reviews the recent article from the journal Gut titled "Long-term budesonide treatment of collagenous colitis: a randomised, double-blind, placebo controlled trial". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2182621 Fri, 13 Feb 2009 13:02:25 +0100 2182621 http://www.medworm.com/index.php?rid=2182622&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fgupta_cjc_200901xx.flv Dr. Sachin Gupta, Endoscopy Research Fellow at St. Mark's Hospital, London, reviews the recent article from the journal Gastroenterology titled "Definition of Phenotypic Characteristics of Childhood-Onset Inflammatory Bowel Disease". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2182622 Fri, 13 Feb 2009 12:02:12 +0100 2182622 http://www.medworm.com/index.php?rid=2027082&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fzeki_cjc_200812xx.flv Dr Sebastian Zeki, Specialist Registrar at St. Mark's Hospital, discusses the recent article in Gut titled "Diagnostic utility of alarm features for colorectal cancer: systematic review and meta-analysis. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2027082 Tue, 09 Dec 2008 17:12:48 +0100 2027082 http://www.medworm.com/index.php?rid=2027083&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fzeki_cjc_2_200812xx.flv Dr Sebastian Zeki, Specialist Registrar at St. Mark's Hospital, discusses the 2006 article from the journal Archives of Surgery titled "Gum chewing reduces ileus after elective open sigmoid colectomy". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=2027083 Tue, 09 Dec 2008 17:12:10 +0100 2027083 http://www.medworm.com/index.php?rid=1984912&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fforcione_cfc_20081014.flv Dr. David Forcione, Instructor in Medicine at Massachusetts General Hospital, discusses choledochal cysts and cholangiocarcinoma. Numerous images are discussed. The presentation was recorded 14 Oct 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1984912 Sun, 23 Nov 2008 06:11:33 +0100 1984912 http://www.medworm.com/index.php?rid=1984911&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fweinstock_cgr_20081028.flv Dr. David Weinstock, Assistant Professor of Medicine at the Dana-Farber/Harvard Cancer Center, delivers Grand Rounds at the MGH GI Unit on the topic IBD and lymphoma. This presentation was recorded 28 October 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1984911 Sun, 23 Nov 2008 06:11:01 +0100 1984911 http://www.medworm.com/index.php?rid=1879903&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fhaycock_cjc_2_20081014.flv Dr. Adam Haycock, Specialist Registrar at St. Mark's Hospital, London, presents journal club on the recent article in Gastrointestinal Endoscopy titled A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1879903 Wed, 15 Oct 2008 09:10:49 +0100 1879903 http://www.medworm.com/index.php?rid=1879902&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fhaycock_cjc_20081014.flv Dr. Adam Haycock, Specialist Registrar at St. Mark's Hospital, London, presents journal club on the recent article in Gut titled "Predicting relapse in Crohn's disease: a biopsychosocial model". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1879902 Wed, 15 Oct 2008 09:10:47 +0100 1879902 http://www.medworm.com/index.php?rid=1841048&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fdespott_cjc_20080917.flv Dr. Edward Despott, Advanced Endoscopy Fellow at St. Mark's Hospital London, reviews the recent article "European Society Gastrointestinal Endoscopy Guidelines: flexible enteroscopy for diagnosis and treatment of small-bowel disease" from the journal Endoscopy. The journal club was recorded 17 September 2009. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1841048 Tue, 30 Sep 2008 08:09:12 +0100 1841048 http://www.medworm.com/index.php?rid=1841051&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fyih-harn_cjc_20080408.flv Dr. Yih-Harn Siaw, Specialist Registrar at St. Mark's Hospital London, presents journal club on the recent article from Gastroenterology titled "Risk Factors for Opportunistic Infections in Patients with Inflammatory Bowel Disease". This journal club was recorded 08 April 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1841051 Mon, 29 Sep 2008 17:09:00 +0100 1841051 http://www.medworm.com/index.php?rid=1841050&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fignjatovic_cjc_20080929.flv Dr. Ana Ignjatovic presents journal club at St. Mark's Hospital London on the recent article in Gut titled "Endoscopic tri-modal imaging for surveillance in ulcerative colitis: Randomized comparison of high resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow band imaging for classification of lesions". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1841050 Mon, 29 Sep 2008 17:09:00 +0100 1841050 http://www.medworm.com/index.php?rid=1841049&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fhaycock_cjc_20080929.flv Dr. Adam Haycock, Endoscopy Teaching Fellow at St. Mark's Hospital London, presents journal club on the topic of antibiotic prophylaxis for Gastrointestinal endoscopy. Publications discussed include "Prophylaxis against infective endocarditis" from the NICE clinical guidance 64, Antibiotic prophylaxis for GI endoscopy: ASGE standards of practice committee. Gastrointest Endosc. 2008 May;67(6):791-8, and "Antibiotic prophylaxis in gastrointestinal endoscopy. BSG guidelines 2001 - updated 2006". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1841049 Mon, 29 Sep 2008 17:09:00 +0100 1841049 http://www.medworm.com/index.php?rid=1841053&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.e.nec.toulouse.shehab.0809fr.mpg.flv Acute necrotizing pancreatitis with secondary infection of pancreatic necrosis is a highly fatal condition. Surgical necrosectomy is the treatment modality of choice with poor outcomes. In this video we describe a technique we have been using more and more recently to achieve debridement of the infected pancreatic necrosis endoscopically. Here is a CT Image of a patient with severe necrotizing pancreatitis showing a huge necrotic cavity with close adherence to the anturm and duodenum confirming the feasibility of an endoscopic approach. On entry into the second part of the duodenum a significant bulge is seen corresponding to the necrotic cavity behind, the most bulging point is chosen as the point of puncture. A needle-knife papillotome is used to form a transmural puncture. After that ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1841053 Thu, 25 Sep 2008 08:09:29 +0100 1841053 http://www.medworm.com/index.php?rid=1841052&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.amp.toulouse.shehab.0809fr.mpg.flv An ampullary adenoma was detected on EGD in this 50 year old man, endoscopic biopsies revealed high-grade dysplasia. Endoscopic ultrasound confirmed the endoscopic resectability of this tumor. The tumor was ensnared completely aiming at an Enbloc resection. A blended current is then cautiously applied until the tumor is successfully resected. Immediately the base of the resection is inspected for any evidence of bleeding or perforation neither of which is evident in this case. The tumor is then retrieved rapidly, it measures about two centimeters in its largest diameter. After a thorough search at the base of the excision the pancreatic duct is detected and successfully cannulated. A guide wire is then left in place over which a short 5 Fr prophylactic pancreatic stent in inserted. Attent... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1841052 Thu, 25 Sep 2008 08:09:04 +0100 1841052 http://www.medworm.com/index.php?rid=1837237&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.bar.sur.sut.end.000.di0808us.mpg.flv In patients who have undergone bariatric surgery via a roux-en-Y gastric bypass, the development of a gastro-gastric fistula between the gastric pouch and defunctionalized stomach is a not too uncommon complication and often leads to weight regain. Closure of these fistulas may be accomplished endoscopically, thus allowing the patient to avoid surgical intervention and its attendant morbidity and mortality. Endoscopic techniques include the use of clips, fibrin glue, and removable stents. The following videos demonstrate a novel technique of endoscopic fistula closure using an endoscopic suturing device. In this first case, we see a large gastro-gastric fistula, approximately 12 mm in diameter, adjacent to the gastro-jejunostomy. The fistula is easily traversed with the gastroscope. A Sav... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1837237 Mon, 01 Sep 2008 07:09:04 +0100 1837237 http://www.medworm.com/index.php?rid=1837238&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.gbs.rep.ooo.rep.1oo.mu0508us.mpg.flv (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1837238 Wed, 20 Aug 2008 17:08:50 +0100 1837238 http://www.medworm.com/index.php?rid=1841054&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.b.stn.rem.sna.for.2ro.sh0508us.mpg.flv (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1841054 Wed, 20 Aug 2008 17:08:48 +0100 1841054 http://www.medworm.com/index.php?rid=1837239&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.sto.ooo.ehl.dac.3oo.sa0508us.mpg.flv (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1837239 Wed, 20 Aug 2008 17:08:38 +0100 1837239 http://www.medworm.com/index.php?rid=1488248&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fforcione_cfc_20080527.flv Dr. David Forcione, Instructor in Medicine at Massachusetts General Hospital, delivers an annual review of pancreas anatomy, physiology, and common developmental anomalities at the MGH GI Unit Fellows' Conference. This lecture was recorded 27 May 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1488248 Mon, 02 Jun 2008 13:06:48 +0100 1488248 http://www.medworm.com/index.php?rid=1488249&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fhuang_cjc_20080529.flv Dr. Edward Huang, GI Fellow at Massachusetts General Hospital, presents an article from Gastroenterology (2006) titled "Distal splenorenal shunt versus transjugular intrahepatic portal systematic shunt for variceal bleeding: a randomized trial". This clinical journal club was recorded 29 May 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1488249 Mon, 02 Jun 2008 13:06:35 +0100 1488249 http://www.medworm.com/index.php?rid=1488251&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Flanghorst_cgr_20080513.flv Dr. Jost Langhorst of the University of Duisburg-Essen presents Clinical Grand Rounds at Massachusetts General Hospital GI Unit. The lecture was recorded 13 May 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1488251 Mon, 02 Jun 2008 13:06:09 +0100 1488251 http://www.medworm.com/index.php?rid=1488250&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fgarber_cjc_20080518.flv Dr. John Garber, GI Fellow at Massachusetts General Hospital, reviews the recent article from the journal Gastroenterology titled "Gastric Cancer Risk in Patients with Premalignant Gastric Lesions: A Nation-wide Cohort Study in the Netherlands". This clinical journal club was recorded 18 May 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1488250 Mon, 02 Jun 2008 13:06:01 +0100 1488250 http://www.medworm.com/index.php?rid=1467872&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.ste.ana.dil.spy.3oo.de0508us.mpg.flv We report a difficult case of a 40F with colonic Crohn's disease who developed a completely obstructed anastomotic stricture. She underwent sigmoidectomy with a temporary diverting ileostomy 4 months prior to presentation for an inflammatory, fibrotic stricture. Prior to ileostomy takedown, she underwent colonoscopy at an outside institution, and this demonstrated a tight anastomotic stricture at about 10cm from the anal verge. A barium enema confirmed the presence of a focal anastomotic stricture (show BE). She was then referred to our unit for endoscopic treatment. At a 4 week interval our endoscopic examination of the anastomotic site revealed a completely obstructed lumen with only a staple visible to mark the distal aspect of the anastomosis. We then used a prototype front view ec... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1467872 Mon, 19 May 2008 07:05:59 +0100 1467872 http://www.medworm.com/index.php?rid=1458564&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.d.div.obs.cli.nif.1oo.ke0508us.mpg.flv A 24-year old female was referred for complaints of intermittent nausea and vomiting with progressive weight loss. An upper GI barium study demonstrates a large diverticulum in the second portion of the duodenum. A thin radiolucent stripe is seen surrounding the diverticulum, which has been described as the “halo” sign. Upper endoscopy is performed which identifies a large diverticulum which intermittently obstructs the duodenal lumen. The endoscopic appearance is consistent with a “windsock” diverticulum. This intraluminal diverticulum is thought to result from incomplete recanalization of the duodenum during embryonic development and, with complete obstruction, symptoms present during childhood. In contrast, when there is a small aperture in the duodenum, patients... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1458564 Mon, 19 May 2008 07:05:59 +0100 1458564 http://www.medworm.com/index.php?rid=1454434&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.pax.ooo.ooo.eus.3or.wi0608us.1.mpg.flv In conclusion, we did not find clinical evidence of a difference between laproscopic and natural orifice distal pancreatectomy. The results of the randomized controlled trial will be reported separately; however, we did not find evidence of an unsuspected untoward outcome with a NOTES approach. The need for a simple, quick and secure gastrotomy closure persists. The importance of rigorous, controlled trials as NOTES moves to human studies is emphasized. Collaboration is critical in defining of current techniques, developing testable hypotheses, and ensuring patient safety. IRB oversight and a focus on patient welfare should guide NOTES studies in any transition to human trials. The authors wish to acknowledge the generous support of the ASGE who enabled this study through an endoscopic re... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454434 Mon, 19 May 2008 07:05:59 +0100 1454434 http://www.medworm.com/index.php?rid=1454433&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.mal.ade.fni.fid.3or.ow0508us.mpg.flv In conclusion this video illustrates another avenue for interventional endoscopic ultrasound. EUS-guided fiducial placement can be considered to help target lesions for stereotactic radiosurgery. Finally, the backloading technique demonstrated here might be useful for implanting other materials to assist in cancer marking or treatment. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454433 Mon, 19 May 2008 07:05:59 +0100 1454433 http://www.medworm.com/index.php?rid=1454432&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.i.als.obs.bal.dil.1oo.pa0508us.1.mpg.flv This is a case of a 71 year-old woman with past medical history of peptic ulcer disease status post Billroth II. She presented with a 3-month history of acute recurrent pancreatitis, postprandial pain, and nausea. Her CT abdomen showed markedly dilated fluid filled proximal jejunum and duodenum. Gallbladder, bile ducts, and pancreatic duct were dilated. Findings are suggestive of afferent loop syndrome. SBFT showed obstruction of the afferent limb in the region of the proximal jejunum with nonopacified duodenum suggesting afferent loop obstruction. Afferent loop syndrome is a rare complication of Billroth II reconstruction. It is a mechanical obstruction of the afferent limb caused by stenosis, ulceration, intussusception or adhesion. Symptoms include postprandial abdominal pain, nausea, v... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454432 Mon, 19 May 2008 07:05:59 +0100 1454432 http://www.medworm.com/index.php?rid=1454431&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.g.mal.ooo.esd.mag.1oo.ki0508us.mpg.flv In conclusion, ESD using magnetic anchor is safe and useful for EGC of gastric body. The magnetic anchor system keeps possibility of minimum invasive endoscopic treatment like ESD and NOTES. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454431 Mon, 19 May 2008 07:05:59 +0100 1454431 http://www.medworm.com/index.php?rid=1454430&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.e.esx.nor.ani.esx.1oo.wi0508us.mpg.flv En Bloc Esophageal Mucosectomy, an experimental technique for the endolumenal management of Barrett's related dysplasia and neoplasia. High grade dysplasia is in indication for esophagectomy; however esophagectomy has a mortality rate up to 12 percent, and up to 56 percent of patients may develop serious post-operative complications. Multiple ablated lesions can progress under the neo-squamous layer, leading to buried Barrett's mucosa. With conventional piecemeal EMR, cautery effect limits evaluation in areas of interest, Barrett's epithelium is left behind, tissue is not evaluated in situ and invasive lesions may be missed due to incomplete sampling. A new technique, en bloc esophageal mucosectomy, or EEM, was developed. The technique begins with conventional EMR in the pro... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454430 Mon, 19 May 2008 07:05:59 +0100 1454430 http://www.medworm.com/index.php?rid=1454429&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.e.bar.mal.esd.ebr.1oo.oy0508us.mpg.flv In conclusion, EDS is a safe and useful procedure for the treatment of superficial esophageal cancer. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454429 Mon, 19 May 2008 07:05:59 +0100 1454429 http://www.medworm.com/index.php?rid=1454428&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.d.div.obs.cli.nif.1oo.ke0508us.mpg.flv A 24-year old female was referred for complaints of intermittent nausea and vomiting with progressive weight loss. An upper GI barium study demonstrates a large diverticulum in the second portion of the duodenum. A thin radiolucent stripe is seen surrounding the diverticulum, which has been described as the “halo” sign. Upper endoscopy is performed which identifies a large diverticulum which intermittently obstructs the duodenal lumen. The endoscopic appearance is consistent with a “windsock” diverticulum. This intraluminal diverticulum is thought to result from incomplete recanalization of the duodenum during embryonic development and, with complete obstruction, symptoms present during childhood. In contrast, when there is a small aperture in the duodenum, patients... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454428 Mon, 19 May 2008 07:05:59 +0100 1454428 http://www.medworm.com/index.php?rid=1454427&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.ste.ana.dil.spy.3oo.de0508us.mpg.flv We report a difficult case of a 40F with colonic Crohn's disease who developed a completely obstructed anastomotic stricture. She underwent sigmoidectomy with a temporary diverting ileostomy 4 months prior to presentation for an inflammatory, fibrotic stricture. Prior to ileostomy takedown, she underwent colonoscopy at an outside institution, and this demonstrated a tight anastomotic stricture at about 10cm from the anal verge. A barium enema confirmed the presence of a focal anastomotic stricture (show BE). She was then referred to our unit for endoscopic treatment. At a 4 week interval our endoscopic examination of the anastomotic site revealed a completely obstructed lumen with only a staple visible to mark the distal aspect of the anastomosis. We then used a prototype front view ec... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454427 Mon, 19 May 2008 07:05:59 +0100 1454427 http://www.medworm.com/index.php?rid=1454426&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.pol.per.esd.rep.6oo.sa0508us.mpg.flv Conclusion In conclusion, conservative clinical management may be possible in patients who have undergone successful colonic perforation closures using endoscpic clipping. In performing immediate endoscopic closure, abdominal decompression has been useful in reducing patient discomfort and preventing colonic lumen collapse in the past, but CO2 insufflations is now being used effectively for the prevention of pneumoperitoneum. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454426 Mon, 19 May 2008 07:05:59 +0100 1454426 http://www.medworm.com/index.php?rid=1454425&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.mal.esd.btn.ooo.6oo.sa0508us.mpg.flv Conclusion: ESD using the newly developed ball-tip B-knife is a safe effective technique for large colorectal tumors. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454425 Mon, 19 May 2008 07:05:59 +0100 1454425 http://www.medworm.com/index.php?rid=1454424&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.b.ste.rec.mag.ooo.2oo.it0508us.mpg.flv Magnetic Compression asastomosis (MCA) used two magnets in conjunction with an interventional radiologic technique to create a non-surgical, sutureless enteric anastomosis. The clinical feasibility, safety, and usefulliness of the MCA technique has been demonstrated for making anastomoses without surgery. The MCA technique makes it possible to perform the canalization in patients with difficult biliary strictures using ERCP and percutaneous transhepatic technique. We first set to evaluate the clinical utility of the MCA technique for choledochocholedochostomy. Before the MCA procedure, we first have to prepare two magnets for both the transpapillary route is 3 or 4 mm in diameter and 9 mm in thickness with a nylon wire 30 cm long attached, In contrast the magnet inserted via the percuta... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454424 Mon, 19 May 2008 07:05:59 +0100 1454424 http://www.medworm.com/index.php?rid=1454423&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.b.ste.ana.ooo.fis.2oo.ja0508us.mpg.flv In conclusion then we describe a novel method for creation of a choledocho-duodenal anastomosis. This method appears simple, safe and economical. It was accomplished in survival studies without any complication. This device may represent a possible alternative to conventional stenting in humans. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454423 Mon, 19 May 2008 07:05:59 +0100 1454423 http://www.medworm.com/index.php?rid=1454422&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.b.ccy.not.gas.ooo.2oo.uj0508us.mpg.flv We describe out technique of transgastric cholecystectomy in humans as developed during several years of laboratory work. Standard endoscope is first used to inspect the stomach and lavage it with antibiotic solution. A critical step is selection of the site of the gastrotomy. The ideal site to exit the stomach is anterior, mid-body which obviates the need for scope retrofelxion during the procedure. We prepare full-thickness sutures 2cm apart to create an imbricated ridge. This will provide a valve to prevent loss of pneumogastrium after removal of the endoscope. To create the ridge and deposits a pledgeted permenant suture. Subsequently a second pledget is deposited on the other side and a cinching device used to tighten it down. A monopolar needle-knife is used to create one centimeter ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1454422 Mon, 19 May 2008 07:05:59 +0100 1454422 http://www.medworm.com/index.php?rid=1556354&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.res.000.000.ooo.ra0805us.mpg.flv (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1556354 Mon, 19 May 2008 07:05:18 +0100 1556354 http://www.medworm.com/index.php?rid=1556355&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.ooo.ani.emr.esd.1oo.ry0508us.mpg.flv The following video aims to showcase the next generation of endoscopic dissection as well as to highlight potential for EMR and NOTES. We begin with the choice of injection solution used in the cut and lift technique of EMR. Most injection solution tends to dissipate quickly. In contrast, Poloxamer 407 is a biocompatible polymer that displays reverse thermo-sensitive characteristics that is the compound exists as a solid gel at body temperature thereby producing a long-lives, submucosal cushion and as a liquid at cold temperatures, allowing for ease of injection. This curious compound has already been studied as an anti-adhesion compound as well as a temporary hemostatic agent in surgery. In this particular study on EMR, Poloxamer 407 is paired with the multi-purpose Olympus R-Scope whic... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1556355 Mon, 19 May 2008 07:05:17 +0100 1556355 http://www.medworm.com/index.php?rid=1556356&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.not.gas.ooo.rep.1oo.as0508us.mpg.flv Although most believe that transgastric rout will be the one to dominate NOTES in the future, there are still some challenges to overcome. This video demonstrates different techniques for gastrotomy closure. The success of the closure depends on how the access to the peritoneal cavity is performed. Several gastrotomy techniques have now been described, but the most commonly used one is the PEG with balloon dilatation that you see demonstrated in here. No matter which technique is favored however it must avoid injury to adjacent organs and maintain adequate access through the gastrotomy for scope passage. The PEG technique seems the one to best fits this criteria because of its less traumatic splitting muscles and this may facilitate closure as the muscles tends to recoil back snugly aroun... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1556356 Mon, 19 May 2008 07:05:16 +0100 1556356 http://www.medworm.com/index.php?rid=1543265&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.gbs.rep.ooo.rep.1oo.mu0508u1.mpg.flv Roux-en-y gastric bypass is a very effective treatment for morbid obesity, but many patients regain weight over time and may require revision procedures. There are multiple causes of weight regain but two contributing factors are stretching of the gastrojejunal anastamosis and of the gastric pouch leading to a decreased satiety response and increased food intake. Surgical revision has a perioperative morbidity as high as 15% and a mortality approaching 1%. As the demand for gastric bypass increases, so will the need for revisions. Given the morbidity and mortality associated with surgery, this presents an opportunity and challenge for gastroenterologists. In this video, we outline three peroral endoscopic suturing techniques for weight regain in the gastric bypass patient. The Bard Endoci... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1543265 Mon, 19 May 2008 07:05:15 +0100 1543265 http://www.medworm.com/index.php?rid=1543266&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.gbs.ooo.ooo.for.1oo.mu0508us.1.mpg.flv Surgical and non-surgical bariatric procedures utilize the insertion of foreign materials into patients which may need to be removed at some later point in time. This poses a unique challenge to the endoscopist. Successful endoscopic removal avoids surgical intervention which can have high morbidity and mortality. In this video, we present three patients who had undergone surgical and non-surgical bariatric procedures and required removal of foreign body material. Our first patient had undergone roux-en-y gastric bypass and developed a complex gastrojejunal anastamotic stricture. Multiple balloon dilations at an outside institution were unsuccessful, and she was referred for possible surgical intervention. On our endoscopy, it was noted that suture material was prohibiting full balloon ex... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1543266 Mon, 19 May 2008 07:05:14 +0100 1543266 http://www.medworm.com/index.php?rid=1543267&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.pse.nec.fwd.eus.300.bi0508us.mpg.flv Conclusion. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1543267 Mon, 19 May 2008 07:05:13 +0100 1543267 http://www.medworm.com/index.php?rid=1522165&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.pse.nec.fis.stn.2oo.me0508us.mpg.flv We herein describe endoscopic treatment of symptomatic pancreatic pseudocyst with significant necrosis and a fistula. Fifty eight year old man had presented to us with a large pseudocyst following an episode of acute pancreatitis. He was complaining of significant abdominal pain for two months. A CT scan abdominal had revealed a large retro-gastric pseudocyst with necrosis and portal venous thrombosis. An upper GI endoscopy had revealed small linear fundal varcies. Endoscopic as well as surgical treatment for the cyst was discussed with the patient. Patient wished not to undergo surgical treatment and therefore endoscopic treatment was selected after a proper consent. EUS was performed to see for the interposed vessel prior to the pseudocyst puncture. Needle knife puncture was made and ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1522165 Mon, 19 May 2008 07:05:12 +0100 1522165 http://www.medworm.com/index.php?rid=1442898&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fhutter_cgr_20080506.flv Dr. Matthew Hutter, Director of the Codman Center for Clinical Effectiveness in Surgery at Massachusetts General Hospital, presents Clinical Grand Rounds at the MGH GI Unit. The discussion includes numerous images of bariatric complications. The presentation was originally recorded 06 May 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1442898 Wed, 14 May 2008 06:05:31 +0100 1442898 http://www.medworm.com/index.php?rid=1436904&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.b.ste.ooo.sem.stn.3oo.al0803us.mpg.flv This case regards a 76 year old lady with painless jaundice. An EUS reveals a carcinoma of the pancreas which is resectable because of vascular invasion. An ERCP reveals a distal biliary stricture as you will see on the fluoroscopic monitor on the right. We are currently placing a ConMed Viabil stent over a guidewire. We're inserting the stent there. I normally like to use a guidewire for placement of the metallic stent because I like to see the tip of the guidewire within the intrahepatics and not in the cystic duct, for instance. We're deploying the stent. Deployment can be stopped at the handle by the technician if the stent deploys too fast, allowing the operator to pull the stent down if necessary. We are following fluoroscopically and we see a smooth deployment there within t... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1436904 Mon, 12 May 2008 07:05:59 +0100 1436904 http://www.medworm.com/index.php?rid=1442899&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.2.pol.vol.clp.pec.6oo.ra0803us.mpg.flv We will demonstrate the retention of resolution clips on a colorectal polypectomy site. One significant complication of colorectal polypectomy is acute or delayed postpolypectomy hemorrhage. Large polyps in the proximal colon, especially >1 cm, carry the greatest risk of postpolypectomy hemorrhage. Hemoclips have been shown to be very effective in treating both immediate and late bleeding in such polyps. In addition, the prophylactic use of hemoclips is associated with a very low risk of postpolypectomy bleeding. In a recent study published in Gastrointestinal Endoscopy in September 2007, clips were identified in 4 out of 10 patients, 3-4 months after polypectomy. All patients were asymptomatic without evidence of infection or erosion around polypectomy site. This is a 63 year old ma... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1442899 Mon, 12 May 2008 07:05:58 +0100 1442899 http://www.medworm.com/index.php?rid=1442900&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.b.hbl.cir.sem.ste.3oo.al0803us.mpg.flv This case presents with a 54 year old female with hepatic cirrhosis (presumed from NASH). She presents with melena jaundice and undergoes EGD and ERCP. Non-bleeding esophageal varices are found, as well as hemobilia. EUS reveals a nest of varices compressing the main bile duct. This is proven by Doppler. The patient is not a candidate for TIPS, surgical shunting, or liver transplant, due to cavernous transformation of the portal vein, splenic vein, and mesenteric vein. She's on beta blockers and is stent dependent due to recurrent obstruction and clot. Stent exchanges are performed at 4-6 month intervals, with prophylactic octreotide infusions. We can see the old stent protruding from the major papilla. It appears occluded. We are ensnaring the stent for removal. Gentle pull to attempt... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1442900 Mon, 12 May 2008 06:05:59 +0100 1442900 http://www.medworm.com/index.php?rid=1426395&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewfilms.cfm%3Ffilm_id%3D736 Dr. Jules Dienstag, Professor of Medicine at Harvard Medical School and Massachusetts General Hospital presents clinical grand rounds at the MGH GI Unit on the topic of "Antiviral Therapy for Chronic Hepatitis C". This presentation was recorded 18 March 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1426395 Wed, 07 May 2008 08:05:35 +0100 1426395 http://www.medworm.com/index.php?rid=1423232&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fperumalsamy_cfc_20080503.flv Drs. Kumaravel Perumalsamy, Jack Tin, Kadirawel Iswara, and Jianjun Li from the Division of Gastroenterology at Maimonides Medical Center in Brooklyn, NY, present novel spy-scope video and information concerning biliary papillomatosis. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1423232 Tue, 06 May 2008 17:05:13 +0100 1423232 http://www.medworm.com/index.php?rid=1423231&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.b.stn.obs.rem.sna.3oo.al0803us.mpg.flv This is the case of an 81 year old gentleman with unresectable adenocarcenoma of the pancreas. He's treated with metallic stenting and presents with recurrent jaundice and colongitis three moths after stent placement. ERCP reveals obstruction of metallic stent. A balloon is placed within the stent and the cholangiogram is performed. As you see on the right screen, there are failing defects within the main bile duct. Balloon extraction yields leafy material; a corn kernel and other food residue. We decide to remove the stent in order to place a newer stent. We ensnare the stent and then gently remove it. It comes easy within the scope channel, even folded over. We recannulate with a balloon in order to completely clear the bile duct with several sweeps. Another Viabil stent is placed. W... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1423231 Tue, 06 May 2008 06:05:08 +0100 1423231 http://www.medworm.com/index.php?rid=1380543&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fmullen_cjc_20080410.flv Dr. Alan Mullen, Clinical and Research Fellow at Harvard Medical School, presented clinical journal club at the MGH GI Unit. The recent article from the journal Gastroenterology titled "Parental Obesity and Offspring Serum Alanine and Aspartate Aminotransferase Levels: The Framingham Heart Study" was presented. This presentation was recorded 10 April 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1380543 Thu, 17 Apr 2008 13:04:03 +0100 1380543 http://www.medworm.com/index.php?rid=1442901&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.1.pol.vol.red.pec.6oo.ra0803us.mpg.flv We will demonstrate the process of epinephrine volume reduction (EVR) of a large sigmoid colon polyp followed by snare resection and retrieval. This is a 74 year old Caucasian male who presented to UTMB for colon cancer screening. During the colonoscopy a large pedunculated polyp that occluded more than half of the lumen was located in the proximal sigmoid colon. Removal of such large polyps is technically difficult and carries a risk of bleeding. Several methods have been used for the resection of such polyps, namely endoscopic resection, en bloc snare resection, piecemeal snare resection and surgical resection. According to a study published in Gastrointestinal Endoscopy in November 2007, epinephrine injection leads to about an 80% volume reduction of large polyps. The benefits of epine... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1442901 Thu, 17 Apr 2008 06:04:11 +0100 1442901 http://www.medworm.com/index.php?rid=1377994&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D753 Dr. Karin Andersson and Dr. Joseph Misdraji, respectively Fellow and Assistant Professor of Medicine at Massachusetts General Hospital and Harvard Medical School, present Liver Case Conference at Massachusetts General Hospital GI Unit. Numerous pathologic slides are reviewed. This presentation was recorded 15 Apr 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1377994 Wed, 16 Apr 2008 08:04:24 +0100 1377994 http://www.medworm.com/index.php?rid=1364933&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.b.4.bil.dct.stn.ooo.600.ra0803us.mpg.flv Endoscopic sphincterotomy (ES) has been a useful method in the removal of common bile duct (CBD) stones for some time. However, in certain patients, stone removal by endoscopic sphincterotomy is unsuccessful due to challenging access to the bile duct, stone size exceeding the diameter of ampullary orifice or impacted stones in the bile duct. In the past, such difficult-to-remove stones were extracted by methods like mechanical lithotripsy, intraductal shock-wave lithotripsy, extracorporeal shock-wave lithotripsy, biliary stenting, and chemical dissolution. Biliary sphincterotomy involves making an incision along the ampullary orifice to make it larger. Another method used to enlarge the biliary sphincter opening is Balloon Sphincteroplasty, which in spite of being popular in the Orient, ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1364933 Thu, 10 Apr 2008 09:04:11 +0100 1364933 http://www.medworm.com/index.php?rid=1354026&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.ste.rem.fna.rem.1oo.go0803us.mpg.flv This 6-minute video describes a reliable technique to remove migrated esophageal stents. Migration of plastic stents used for benign disease is a frequent problem Most of the time they are easy to remove but difficult situations with prolonged procedure times and repeated failures to capture and remove stents do occur. Repeated unsuccessful removal attempts and the use of more force exert stress on weakened sections of the anatomy, for example when removing stents after anastomotic leaks and perforations. In our method the common problem of stent slippage during removal attempts is avoided by piercing an FNA needle through the front and back of a migrated plastic stent close to its end. Subsequently a guidewire is advanced through the FNA needle and received with a polypectomy snare, which... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1354026 Mon, 07 Apr 2008 14:04:18 +0100 1354026 http://www.medworm.com/index.php?rid=1352067&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.c.flt.dep.les.sagi.utmb.ra0804.mpg.flv Dr. Sashidhar Sagi and Dr. Gottumukkala Raju, from the University of Texas Medical Branch, review the clinical significance and endoscopic appearance of flat and depressed colonic lesions. The recently published paper in JAMA by Soetikno et al. titled "Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults" has brought this issue significant recent attention. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1352067 Fri, 04 Apr 2008 07:04:28 +0100 1352067 http://www.medworm.com/index.php?rid=1349589&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D737 Dr. Michael Thiim, Clinical Instructor in Medicine at Massachusetts General Hospital, presents clinical fellows conference on the topic of "Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis". This presentation was recorded 18 March 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1349589 Thu, 03 Apr 2008 17:04:55 +0100 1349589 http://www.medworm.com/index.php?rid=1346162&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.marciano.chole.cyst.02232008.mpg.flv This is a 10-year-old girl who presented to the emergency room with RUQ abdominal pain, which awoke her from sleep. Her liver tests were significant for an AST of 901 and an ALT of 641 with a normal bilirubin and alkaline phophatase. An abdominal ultrasound revealed a focal lesion in the left hepatic lobe with dilatation of the extrahepatic biliary tree. A ct scan showed a left medial and lateral hepatic lesion with dilatation of the main hepatic duct with wall enhancement. Prominent branches of the hepatic artery and vein were seen. In addition, there was mild irregular dilatation of the extra hepatic duct, tapering inferiorly in the region of the pancreatic head. An MRCP was obtained; the left intrahepatic bile ducts were dilated and disorganized. A filling defect was seen in the left h... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1346162 Wed, 02 Apr 2008 16:04:56 +0100 1346162 http://www.medworm.com/index.php?rid=1346161&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.s.gis.fna.eus.bio.1oo.se0803us.mpg.flv This patient is a 73 yo female who was referred for evaluation after a submucosal lesion was seen on endoscopy. Endoscopy was repeated which demonstrated a pre-pyloric outpouching, with smooth, intact, normal overlying mucosa. It was unclear whether this lesion originated from mucosal or submucosal tissue. Endoscopic ultrasound (EUS) was subsequently performed and was consistent with a gastrointestinal stromal cell tumor (GIST). Classic EUS features of a GIST as seen here are dark or hypoechoic appearance, round to oval shape, with location in the 4th sonographic layer, corresponding to the muscularis propria. Here we see another EUS image from a different patient with GIST. In this case, the GIST is also round, hypoechoic, and located in the 4th sonographic layer. In this image from anoth... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1346161 Wed, 02 Apr 2008 16:04:24 +0100 1346161 http://www.medworm.com/index.php?rid=1346163&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.dimaio.mgh.ipmn.cyst.mpg.flv A 36 year old woman was referred to the Massachusetts General Hospital for evaluation of an incidental pancreatic cystic lesion found on abdominal ultrasound. An abdominal CT confirmed the finding, demonstrating a 5 cm multi-cystic lesion in the pancreatic head, with diffuse dilation of the pancreatic duct in the body and tail. ERCP and EUS performed at an outside institution were non-diagnostic. However, the EUS at the outside hospital demonstrated an intramural nodule, raising concern for malignancy, and thus warranting further evaluation. The patient was subsequently seen at the MGH. Endoscopic evaluation demonstrated a patulous ampulla. A pancreatogram was obtained and demonstrated a large, cystic dilation of the pancreatic duct in the head. Aspiration of 10 cc of pancreatic duct fluid... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1346163 Wed, 02 Apr 2008 15:04:03 +0100 1346163 http://www.medworm.com/index.php?rid=1344291&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D743 Dr. Parth Paskaran presents St. Mark's Hospital GI Journal Club on the article from Diabetic Medicine titled "Oesophageal dysmotility, delayed gastric emptying and gastrointestinal symptoms in patients with diabetes Mellitus". This presentation was recorded 01 April 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1344291 Tue, 01 Apr 2008 17:04:48 +0100 1344291 http://www.medworm.com/index.php?rid=1344290&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D744 Dr. Parth Paskaran delivered St. Mark's Hospital GI Journal Club on the recent article in Gastroenterology titled "Rosiglitazone for Active Ulcerative Colitis: A Randomized Placebo-Controlled Trial". This presentation was recorded 01 April 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1344290 Tue, 01 Apr 2008 17:04:17 +0100 1344290 http://www.medworm.com/index.php?rid=1329080&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fbaron.mayo.sphinct.ba200801.mpg.flv Dr. Georgios Papachristou and Dr. Todd Baron, physicians at Mayo Clinical College of Medicine, present a demonstration of precut biliary sphincterotomy using the precut fistulotomy technique. This video contains multiple clinical cases and diagrams to highlight different aspects of this technique. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1329080 Wed, 26 Mar 2008 16:03:01 +0100 1329080 http://www.medworm.com/index.php?rid=1327515&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D738 Dr. Peter Carolan, Clinical and Research Fellow in Medicine at Harvard Medical School, presents clinical journal club on the December 2007 article in the journal Hepatology titled "Treatment extension to 72 weeks of peginterferon and ribavirin in hepatitis c genotype 1-infected slow responders". This presentation was recorded on 20 March 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1327515 Tue, 25 Mar 2008 06:03:15 +0100 1327515 http://www.medworm.com/index.php?rid=1297795&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D735 Dr. Ken McQuaid, Chief of the Gastroenterology Section at the San Francisco VA Medical Center, presents clinical grand rounds at the MGH GI unit on the topic of microscopic colitis. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1297795 Wed, 12 Mar 2008 15:03:18 +0100 1297795 http://www.medworm.com/index.php?rid=1283483&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fd.leung.stanford.erode.so0802.mpg.flv A 73 yo man presented with a three day history of hematemesis. Three days prior, he began vomiting red blood, progressively larger in quantity. His past medical history was most notable for CAD, atrial fibrillation (off coumadin), and renal cell carcinoma. 8 months prior to presentation the patient underwent embolization and right nephrectomy for his renal cell carcinoma. Of note, a CT scan, 1 month prior to presentation showed: a paraaortic and paracaval mass 6.7cm x 4.8cm in diameter, and paraaortic and paracaval lymphadenopathy. On upper endoscopy, a large 2-3cm pulsating hematoma was found in the second portion of the duodenum; likely an erosion of an extrinsic mass into the duodenum. A mucosal defect at the tip of the hematoma was oozing blood intermittently. A side-viewing endoscop... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1283483 Thu, 06 Mar 2008 07:03:39 +0100 1283483 http://www.medworm.com/index.php?rid=1283484&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.p.oshea.utmb.sphinc.200712ra.mpg.flv Pancreas divisum is a failure of the ventral and dorsal pancreatic ducts to fuse in utero resulting in the major portion of pancreatic secretions entering the duodenum by the minor papilla. Pancreas divisum is the most common congenital pancreatic anomaly occurring in approximately 7% of autopsy subjects. Approximately 95% of patients with pancreas divisum are asymptomatic. The diagram of the anatomy of the pancreas in the presentation illustrates pancreatic divisum showing the relationship of the dorsal duct (Santorini) to the minor ampulla and the ventral duct (Wirsung) to the major ampulla. The diagnosis of pancreas divisum is made by Computed tomography (CT) scan, Magnetic resonance cholangiopancreatography (MRCP), or Endoscopic retrograde cholangiopancreatography (ERCP). A CT scan c... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1283484 Thu, 06 Mar 2008 06:03:57 +0100 1283484 http://www.medworm.com/index.php?rid=1271841&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fe.leung.stanford.black.so0802.mpg.flv An 89 yo man presented with a history of black, tarry stools for 1 day. His past medical history was notable for atrial fibrillation with rapid ventricular response, hypertension, and a complicated urologic history with large exophytic renal cysts, urethral stricture, abdominal abscess, fungal UTI, and acute renal failure requiring bilateral nephrostomy tubes. An upper endoscopy revealed severe circumferential ulceration of the entire esophagus beginning at the gastro-esophageal junction. There was also a brown-yellow particulate matter on the esophagus surface which when washed revealed a black-brown appearing esophageal mucosa consistent with “black esophagus.” Post-EGD, he was placed on maximal proton pump inhibitor doses and sucralfate and gradually started a clear liquid ... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1271841 Sun, 02 Mar 2008 08:03:32 +0100 1271841 http://www.medworm.com/index.php?rid=1271842&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Fflash%2Fevca.e.mittal.utmb.pap.200712ra.mpg.flv In conclusion squamous cell papilloma is an uncommon benign esophageal tumor which must be removed in all patients because of concern regarding malignant potential. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1271842 Sun, 02 Mar 2008 08:03:19 +0100 1271842 http://www.medworm.com/index.php?rid=1266593&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D734 Dr. Stephen Goldfinger, Professor of Medicine at Harvard Medical School, presents Clinical Grand Rounds at the MGH GI Unit on the topic of islet cell tumors and carnicoids. This grand rounds was originally recorded 10 January 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1266593 Thu, 28 Feb 2008 14:02:58 +0100 1266593 http://www.medworm.com/index.php?rid=1266595&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D732 This article review was recorded 26 February 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1266595 Thu, 28 Feb 2008 10:02:58 +0100 1266595 http://www.medworm.com/index.php?rid=1266594&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fviewilms.cfm%3Ffilm_id%3D733 This article review was recorded 26 February 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1266594 Thu, 28 Feb 2008 10:02:50 +0100 1266594 http://www.medworm.com/index.php?rid=1255080&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fhaycock_cjc_2_200802%2Fhaycock_cjc_2_200802.htm Dr. Adam Haycock, Endoscopy Fellow at St. Mark's Hospital, reviews the recent article from Digestive Diseases and Sciences titled "The Perception of Gastroenterology Fellows towards the Relationship between Hand Size and Endoscopic Training". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1255080 Mon, 25 Feb 2008 17:02:00 +0100 1255080 http://www.medworm.com/index.php?rid=1255079&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fpuder_cgr_20080219%2Fpuder_cgr_20080219.htm Dr. Mark Puder, Associate in Surgery at Children's Hospital Boston, presents clinical grand rounds on "The Role of Lipid Emulsions in the Treatment of PN Associated Liver Disease". The presentation includes discussion of PN liver injury, risk factors, current treatment options, experimental laboratory studies on omega-3 lipids emulsions, and clinical cases. This grand rounds was recorded 19 Feb 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1255079 Mon, 25 Feb 2008 07:02:56 +0100 1255079 http://www.medworm.com/index.php?rid=1252835&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fhaycock_cjc_200802%2Fhaycock_cjc_200802.htm Dr. Adam Haycock, Endoscopy Fellow at St. Mark's Hospital, reviews the recent article from Gut titled "The effects of population-based faecal occult blood test screening upon emergency colorectal cancer admissions in Coventry and north Warwickshire". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1252835 Sat, 23 Feb 2008 09:02:25 +0100 1252835 http://www.medworm.com/index.php?rid=1252838&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fyoud_cjc_20080122%2Fyoud_cjc_20080122.htm This article review was recorded 22 January 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1252838 Sat, 23 Feb 2008 08:02:48 +0100 1252838 http://www.medworm.com/index.php?rid=1252836&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fdespott_cjc_2_20080205%2Fdespott_cjc_2_20080205.htm This article review was recorded 5 February 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1252836 Sat, 23 Feb 2008 08:02:44 +0100 1252836 http://www.medworm.com/index.php?rid=1252837&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fdespott_cjc_20080205%2Fdespott_cjc_20080205.htm This article review was recorded 5 February 2008. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1252837 Sat, 23 Feb 2008 08:02:33 +0100 1252837 http://www.medworm.com/index.php?rid=1252839&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fjacyna_cjc_2_200801%2Fjacyna_cjc_2_200801.htm Dr. Meron Jacyna, Gastroenterologist at St. Marks Hospital, reviews the recent article from the journal Gut titled "Long-term Prognosis of Autoimmune Pancreatitis without and with Corticosteroid Treatment". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1252839 Sat, 23 Feb 2008 07:02:57 +0100 1252839 http://www.medworm.com/index.php?rid=1252840&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fjacyna_cjc_200801%2Fjacyna_cjc_200801.htm Dr. Meron Jacyna, Gastroenterologist at St. Marks Hospital, reviews the recent article from the journal Gut titled "Pancreatic cancer regression by intratumoral injection of live Streptococcus pyogenes in a syngeneic mouse model". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1252840 Sat, 23 Feb 2008 07:02:50 +0100 1252840 http://www.medworm.com/index.php?rid=1236221&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fandersson_cfc_20071218%2Fandersson_cfc_20071218.htm Dr. Karin Andersson, Clinical and Research Fellow in Medicine at Harvard Medical School, present Liver Cases Conference. The topic is complications, beginning with a case involving a skin rash in a patient in treatment for HCV. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1236221 Fri, 15 Feb 2008 13:02:00 +0100 1236221 http://www.medworm.com/index.php?rid=1236222&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Frodriguez_cgr_20080205%2Frodriguez_cgr_20080205.htm Dr. Leonel Rodriguez, Medical Director of the Pediatric Intestinal Rehabilitation Program at Massachusetts General Hospital, presents Clinical Grand Rounds at the MGH GI Unit. The presentation includes remarks on the definition, epidemiology, pathophysiology, etiology, diagnosis, treatment, and prognosis of chronic intestinal pseudo-obstruction and is focused on the pediatric population. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1236222 Fri, 15 Feb 2008 12:02:00 +0100 1236222 http://www.medworm.com/index.php?rid=1236223&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fwillingham_cjc_20080117%2Fwillingham_cjc_20080117.htm Dr. Field Willingham, Clinical and Research Fellow in Medicine at Harvard Medical School, reviews the April 1, 1993 landmark article from the New England Journal of Medicine titled "Randomized Comparison of Surveillance Intervals after Colonoscopic Removal of Newly Diagnosed Adenomatous Polyps". The article is part of the National Polyp Study conducted jointly by the AGA, ASGE and ACG. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1236223 Fri, 15 Feb 2008 09:02:28 +0100 1236223 http://www.medworm.com/index.php?rid=1236224&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fforcione_cfc_20080212%2Fforcione_cfc_20080212.htm Dr. David Forcione, Instructor in Medicine at Harvard Medical School, reviews the history, current practice, and future directions of esophageal and enteral stenting at the MGH GI Unit Fellows Conference. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1236224 Fri, 15 Feb 2008 09:02:00 +0100 1236224 http://www.medworm.com/index.php?rid=1236225&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fyachimski_cjc_20080214%2Fyachimski_cjc_20080214.htm Dr. Patrick Yachimski, Clinical and Research Fellow in Medicine at Harvard Medical School, reviews two recent articles from the journal Gut. The first is "A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect?". The second is "Narrow band imaging for colonoscopic surveillance in hereditary non-polyposis colorectal cancer". (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1236225 Thu, 14 Feb 2008 17:02:00 +0100 1236225 http://www.medworm.com/index.php?rid=1190018&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fsyngal_cgr_20080129%2Fsyngal_cgr_20080129.htm Dr. Sapna Syngal, Associate Director of the Clinical Academic Fellowship Training Program at Brigham and Womens Hospital. This lecture includes information on genetic testing for, among others, hereditary colorectal cancer, familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, hamartomatous polyposis syndromes. The role of family history assessment for genetic conditions is also discussed. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1190018 Tue, 29 Jan 2008 17:01:00 +0100 1190018 http://www.medworm.com/index.php?rid=1173205&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Freal%2Fkasturi.utmb.scleroderma.0711ra.mpg.rm This presentation features a case of Scleroderma with characteristic upper GI involvement. The endoscopy findings, pathophysiology, diagnostic evaluation, and management strategies are discussed briefly. Case: A 57-year-old Caucasian female with past medical history of Scleroderma presented to our gastroenterology clinic for further evaluation of a 2-week history of dysphagia for solids and liquids. She also had a chronic gastroesophageal reflux disease that responded partially to proton pump inhibitors, and recurrent episodes of aspiration pneumonia. Work-up: As part of her diagnostic work-up, a barium swallow was done that showed diminished esophageal peristalsis and a patulous gastroesophageal junction. A liquid gastric emptying study was abnormally prolonged. An esophageal manometr... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1173205 Wed, 23 Jan 2008 11:01:56 +0100 1173205 http://www.medworm.com/index.php?rid=1158226&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Fullman_cgr_20080115%2Fullman_cgr_20080115.htm Dr. Thomas Ullman, Assistant Professor of Medicine at the Mount Sinai School of Medicine presents Clinical Grand Rounds at the MGH GI Unit. The discussion reviews the natural history of neoplastic progression in IBD and some of Dr. Ullmans own research. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1158226 Tue, 15 Jan 2008 17:01:00 +0100 1158226 http://www.medworm.com/index.php?rid=1139796&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Freal%2Fsingh.utmb.endolp.lig.0711ra.mpg.rm A 64 y/o man presented for elective gastric polyp resection. After giving 1:10,000 epinephrine, polyp is snared and removed by electric cautery. To decrease the risk of subsequent bleeding, endoloop ligation is done. Loop is placed around the stalk. It is slowly tightened to include the surrounding mucosa with the stalk. Because the polypectomy site is wide, a second loop is placed to further reduce the risk of bleeding. On histological examination, it is found to be a hyperplastic polyp. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1139796 Wed, 09 Jan 2008 17:01:01 +0100 1139796 http://www.medworm.com/index.php?rid=1139797&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fpresentations%2Frustgi_cgr_20080108%2Frustgi_cgr_20080108.htm Dr. Anil Rustgi, Director of the Center for Molecular Studies in Digestive and Liver Diseases at the University of Pennsylvania delivers the 4th annual Nath Memorial Lecture at Massachusetts General Hospital GI Unit. The topic of discussion is pancreatic cancer, focusing on gene mutation and pathology. (Source: The Digital Atlas of Video Education - Gastroenterology) The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1139797 Tue, 08 Jan 2008 17:01:00 +0100 1139797 http://www.medworm.com/index.php?rid=1128754&cid=s_34966_17_f&fid=34966&url=http%3A%2F%2Fdaveproject.org%2Fmedia%2Fvideos%2F512k%2F480x320%2Freal%2Fshah.stentpull.0711sh.mpg.rm An 81 year old male was referred to our institution for ercp after having unsuccessful biliary stone extraction at an outside institution. Initial fluoroscopic image revealed proximal migration of a CBD stent that had been placed to maintain drainage. Endoscopy confirmed upward migration of the stent. The Spyglass Direct Access Visualization System is used to access the common bile duct over a long wire. The Spy bite biopsy forceps is then inserted through the Spy catheter and advanced into the bile duct. The CBD stent is easily visualized. The stent is grasped with the forceps and is pulled downward into the distal common bile duct. Once the stent is pulled into the duodenal lumen it is grasped and removed using a standard snare. The CBD stone was then successfully removed using Spyglas... The Digital Atlas of Video Education - Gastroenterology info http://www.medworm.com/rss/comments.php?id=1128754 Thu, 03 Jan 2008 09:01:54 +0100 1128754