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EUS for Staging of Rectal CancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: The Digital Atlas of Video Education - Gastroenterology - November 9, 2009 Category: Gastroenterology Authors: Jonathan M Buscaglia, MD, Instructor of Medicine, Johns Hopkins Medical Center Source Type: info

Transgastric Endoscopic Necrosectomy for Walled-Off Pancreatic NecrosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 perc...
Source: The Digital Atlas of Video Education - Gastroenterology - October 28, 2009 Category: Gastroenterology Authors: Amaar Ghazale, MD,, University of Michigan, Akbar K. Waljee, MD,, University of Michigan, Craig M. Womeldorph MD,, University of Michigan, B. Joseph Elmunzer, MD,, University of Michigan Source Type: info

Esophagus - Band Ligation of Actively Bleeding Gastroesophageal VaricesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 activel...
Source: The Digital Atlas of Video Education - Gastroenterology - October 28, 2009 Category: Gastroenterology Authors: Lauren Layer, Medical Student, University of Texas Medical Branch, Sathya Jaganmohan, MD, GI Fellow, University of Texas Medical Branch, Gottumukkala S. Raju, M.D., Director of Endoscopy, Center for Endoscopic Research, Training and Innovation, University Source Type: info

PseudomelanosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 c...
Source: The Digital Atlas of Video Education - Gastroenterology - October 21, 2009 Category: Gastroenterology Authors: Mohammad Bilal,, Harvard Medical School, David G. Forcione, M.D., Instructor in Medicine, Harvard Medical School, Massachusetts General Hospital, Peter B. Kelsey, M.D., Assistant Professor of Medicine, Harvard Medical School, Massachusetts General Hospita Source Type: info

Case Study: Endoscopic Ultrasound (EUS) Guided-Celiac Plexus Neurolysis (CPN)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 th...
Source: The Digital Atlas of Video Education - Gastroenterology - October 19, 2009 Category: Gastroenterology Authors: Mohamad A. Eloubeidi, M.D, Associate Professor of Medicine and Pathology, University of Alabama at Birmingham Source Type: info

Intestine - Total Gastrectomy with EsophagojejunostomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 attem...
Source: The Digital Atlas of Video Education - Gastroenterology - August 20, 2009 Category: Gastroenterology Authors: Chandra S. Dasari, MD,, MD Anderson Cancer Center, Gottumukkala S. Raju, M.D., Professor of Medicine, MD Anderson Cancer Center Source Type: info

Pancreas - Advancing the Principles of Minimally Invasive Surgical Therapy: A Percutaneous, Combined IR / Flexible Endoscopic Pancreatic NecrosectomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - August 20, 2009 Category: Gastroenterology Authors: Matthew T. Moyer, MD, MS, Clinical Instructor, Penn State Milton S. Hershey Medical Center, Arnab Biswas, DO,, Penn State Milton S. Hershey Medical Center, Abraham Mathew, MD, Associate Professor, Penn State Milton S. Hershey Medical Center, Frank C. Lync Source Type: info

Biliary - Multiple Liver Microabscesses in Malignant Biliary Obstruction; EUS viewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: The Digital Atlas of Video Education - Gastroenterology - August 12, 2009 Category: Gastroenterology Authors: Manmeet Padda, MD,, Yale University, Uzma Siddiqui, M.D., Assistant Professor of Medicine, Yale University Source Type: info

Racial and Ethnic Disparities in Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - July 8, 2009 Category: Gastroenterology Authors: Andrea E. Reid, MD, MPH, Assistant Professor of Medicine, Harvard Medical School Source Type: info

NOTES Transrectal Rectosigmoid ResectionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - July 8, 2009 Category: Gastroenterology Authors: Patricia Sylla, MD, Instructor in Surgery, Massachusetts General Hospital Source Type: info

Duodenum - Leaking Roof Concept of Duodenal UlcersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 co...
Source: The Digital Atlas of Video Education - Gastroenterology - July 7, 2009 Category: Gastroenterology Authors: Chandra S. Dasari,, MD Anderson Cancer Center, Gottumukkala S. Raju, M.D., Professor of Medicine, MD Anderson Cancer Center Source Type: info

Endoscopic Resection of Distal Bile Duct MassEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 s...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Shyam S. Varadarajulu, MD,, University of Alabama at Birmingham Source Type: info

Direct Peroral Cholangioscopy in the Management of Refractory Stone DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, fiberopti...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Gregory A. Cote, MD, MS,, University of Washington Source Type: info

Pancreatic Balloon Sphincteroplasty For Removal of Large Radiolucent Pancreatic StonesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Amit P. Maydeo, MD,, Institute of Advanced Endoscopy Source Type: info

Endoscopic Anastomosis Between the Cystic Duct Stump and a Severed Aberrant Right Hepatic DuctEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 u...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Guido Costamagna, MD,, Catholic University, Rome Source Type: info

Therapeutic EUS for the Treatment of a Pancreaticopleural FistualEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 standar...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Scott T. Cooper, MD,, University of Pittsburgh Source Type: info

Direct Pancreatoscopy with Narrow Band Imaging in Patient with Pancreas Divisum and Intraductal Papillary Mucinous NeoplasmEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Daniel A. Ringold, MD,, University of Colorado Denver Source Type: info

Digital Cholangioscopy with Narrow Band Imaging and Confocal MicroscopyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Ram Chuttani, M.D., Chief of Endoscopy, Beth Israel Deaconess Medical Center Source Type: info

EUS-guided Biliary Drainage with One-step Placement of Newly Designed Fully Covered Metal Stent for Malignant Biliary Obstruction: A Prospective Feasibility StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Do Hyun Park, M.D. PhD, Physician, Soon Chun Hyang University Source Type: info

Advanced Endoscopic Pancreaticobiliary Therapy in Surgically-Altered Enteral AnatomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 encount...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Marvin Ryou, MD,, Brigham and Women's Hospital Source Type: info

Peroral Cholangioscopy: Removal of Foreign Body From Biliary TreeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 p...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Shahzad Iqbal, MD,, Columbia University Medical Center Source Type: info

Endoluminal Treatment of Obesity: First Case Report of Transoral Gastroplasty in the USEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 g...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Gregory A. Cote, MD, MS,, University of Washington Source Type: info

Feasibility of Small Bowel Resection by NOTES Transgastric and Transvaginal ApproachEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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-...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Elena Dubcenco, MD,, Johns Hopkins Medical Center Source Type: info

NOTES Transgastric Hernia Repair in a Porcine ModelEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ase...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: David J. Desilets, MD, PhD,, Source Type: info

Lower Gastrointestinal Bleeding in a Post Kidney Pancreas Transplant PatientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Srikrishna Vemana, MD,, University Hospitals Case Medical Center Source Type: info

Endoscopic Treatment of Gallstone Illeus of the ColonEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 s...
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Todd H. Baron, M.D., Professor of Medicine, Mayo Clinic Source Type: info

Enteral Stent Placement Using Spiral Enteroscopy for Malignant Mid-jejunal ObstructionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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....
Source: The Digital Atlas of Video Education - Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Eun J. Shin, MD,, Johns Hopkins Medical Center, Anne Marie Lennon, MD,, Johns Hopkins Medical Center, Patrik I. Okollo III, MD, MPH,, Johns Hopkins Medical Center Source Type: info

Colon - Spurting Vessel within a Rectal Ulcer Treated with ClipsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 re...
Source: The Digital Atlas of Video Education - Gastroenterology - May 13, 2009 Category: Gastroenterology Authors: Harry Aslanian, M.D., Assistant Professor of Medicine, Yale University, Catherine McCrann, MD, GI Fellow, Yale University Source Type: info

Colon - Endoloop Ligation of Large Pedunculated Submucosal TumorsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 pseudope...
Source: The Digital Atlas of Video Education - Gastroenterology - April 25, 2009 Category: Gastroenterology Authors: Suck-Ho Lee, MD, PhD, Advanced Endoscopy Research Fellow, Soonchunhyang University, Cheonan, Korea, Beth Israel Deaconess Medical Center, Harvard Medical School Source Type: info

Pancreas - Transduodenal Drainage of a Pancreatic Pseudocyst with fully-coated SEMSEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 compr...
Source: The Digital Atlas of Video Education - Gastroenterology - April 25, 2009 Category: Gastroenterology Authors: James Corasanti, MD, PhD, Director of Endoscopy, Buffalo General Hospital Source Type: info

Pancreas - Serous Cyst with BleedingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 aspirati...
Source: The Digital Atlas of Video Education - Gastroenterology - April 23, 2009 Category: Gastroenterology Authors: William R. Brugge, M.D., Associate Professor of Medicine, Harvard Medical School, Massachusetts General Hospital Source Type: info

Biliary - Type III Choledochal Cyst with Biliary Reflux through the Minor Papilla; Needle Knife Major PapillotomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 suc...
Source: The Digital Atlas of Video Education - Gastroenterology - April 23, 2009 Category: Gastroenterology Authors: Jose Vega-Peralta, MD,, Hennepin County Medical Center, University of Minnesota, Martin L. Freeman, M.D., Professor of Medicine, Hennepin County Medical Center, University of Minnesota Source Type: info

What's New in Hereditary Colon Cancer?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - April 21, 2009 Category: Gastroenterology Authors: Daniel C. Chung, M.D., Clinical Director, Gastrointestinal Cancer Genetics Program, Harvard Medical School, Massachusetts General Hospital Source Type: info

Whats New in Hereditary Colon Cancer?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - April 21, 2009 Category: Gastroenterology Authors: Daniel C. Chung, M.D., Clinical Director, Gastrointestinal Cancer Genetics Program, Harvard Medical School, Massachusetts General Hospital Source Type: info

Hepatitis C After Liver TransplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - April 21, 2009 Category: Gastroenterology Authors: Fredric D. Gordon, MD, Assistant Professor of Medicine, Tufts University School of Medicine Source Type: info

Two Cases from Fellows RoundsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - March 31, 2009 Category: Gastroenterology Authors: Hamed Khalili, MD, GI Fellow, Massachusetts General Hospital Source Type: info

Surgery in the Patient with Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - March 29, 2009 Category: Gastroenterology Authors: Lawrence S. Friedman, M.D., Chief of Medicine, Newton-Wellesley Hospital Source Type: info

Fellows Conference: HepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - March 27, 2009 Category: Gastroenterology Authors: Daniel S. Pratt, M.D., Assistant Professor of Medicine, Harvard Medical School, Massachusetts General Hospital Source Type: info

Stomach - GIST with EUS FNAEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: The Digital Atlas of Video Education - Gastroenterology - March 25, 2009 Category: Gastroenterology Authors: Manmeet Padda, MD,, Yale University, Harry Aslanian, M.D., Assistant Professor of Medicine, Yale University Source Type: info

Duodenum - Carcinoid Tumor, with EUS FNAEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 neuro...
Source: The Digital Atlas of Video Education - Gastroenterology - March 25, 2009 Category: Gastroenterology Authors: William R. Brugge, M.D., Associate Professor of Medicine, Harvard Medical School, Massachusetts General Hospital Source Type: info

Stomach - Carcinoid Tumor with EUSEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: The Digital Atlas of Video Education - Gastroenterology - March 25, 2009 Category: Gastroenterology Authors: William R. Brugge, M.D., Associate Professor of Medicine, Harvard Medical School, Massachusetts General Hospital Source Type: info

GI Manifestations of HIVEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - March 24, 2009 Category: Gastroenterology Authors: Nesli Basgoz, M.D., Associate Chief and Clinical Director, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School Source Type: info

Case: A woman with a bleeding fingerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - March 24, 2009 Category: Gastroenterology Authors: Barham Abu Dayyeh, MD, GI Fellow, Massachusetts General Hospital Source Type: info

Infliximab prevents Crohns Disease Recurrence After Ileal ResectionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - March 23, 2009 Category: Gastroenterology Authors: Dr. J Macnaughtan,, St Mark's Hospital, UK Source Type: info

Therapy of Metronidazole with Azathioprine to prevent postoperative recurrence of Crohns DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - March 23, 2009 Category: Gastroenterology Authors: Dr. J Macnaughtan,, St Mark's Hospital, UK Source Type: info

Colorectal Cancer ScreeningEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - March 17, 2009 Category: Gastroenterology Authors: Daniel C. Chung, M.D., Clinical Director, Gastrointestinal Cancer Genetics Program, Harvard Medical School, Massachusetts General Hospital Source Type: info

Esophagus - Malignant Esophageal Stricture at the Esphageal IntroitusEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: The Digital Atlas of Video Education - Gastroenterology - March 3, 2009 Category: Gastroenterology Authors: Shou Jiang Tang, MD, Assistant Professor of Internal Medicine, University of Texas Southwestern Medical Center, Manmeet Padda, MD,, Yale University Source Type: info

Stomach - Hiatal HerniaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: The Digital Atlas of Video Education - Gastroenterology - March 3, 2009 Category: Gastroenterology Authors: Sashidhar Sagi, MD, Resident in Internal Medicine, University of Texas Medical Branch, Amanpal Singh, MD,, University of Texas Medical Branch, Gottumukkala S. Raju, M.D., Director of Endoscopy, Center for Endoscopic Research, Training and Innovation, Univ Source Type: info

GI Motility Testing- SmartPill: A Diagnostic Device to Fulfill A Unmet Clinical Need?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - February 25, 2009 Category: Gastroenterology Authors: Braden Kuo, M.D., Instructor in Medicine, Harvard Medical School, Massachusetts General Hospital Source Type: info

Long-term budesonide treatment of collagenous colitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: The Digital Atlas of Video Education - Gastroenterology - February 13, 2009 Category: Gastroenterology Authors: Dr. Sachin Gupta, Endoscopy Research Fellow, St Mark's Hospital, UK Source Type: info