DAVE Project - Gastroenterology

Endoscopic Diagnosis of Secondary Aortoenteric Fistula

admin — Fri, 17 May 2013 09:32:46 +0000

Stanley Yakubov, MD, Albert Einstein College of Medicine, Maimonides Medical Center
Steven Shamah, MD, Albert Einstein College of Medicine, Maimonides Medical Center
Joseph Hanono, MD, Albert Einstein College of Medicine, Maimonides Medical Center
Maryanne Ruggiero, MD, Albert Einstein College of Medicine, Maimonides Medical Center
Ira Mayer, MD, Albert Einstein College of Medicine, Maimonides Medical Center
Jack Braha, DO, Albert Einstein College of Medicine, Maimonides Medical Center

An 88 yr old female presented to the Emergency Department with black tarry stool for two weeks along with weakness, fatigue and hypotension. Past Medical History was significant for Coronary artery disease, Hypertension, Diabetes and a surgical history of AAA repair 8 years prior to admission. On Physical examination temperature was 95.5 degrees [...]

Treatment of Multiple Angioectasias with APC

admin — Mon, 13 May 2013 05:43:26 +0000

Christian Jackson, MD, Loma Linda VA Medical Center, Loma Linda University Medical Center
Elliot Joo, MD, Loma Linda VA Medical Center, Loma Linda University Medical Center
Scott Lee, MD, Loma Linda VA Medical Center, Loma Linda University Medical Center

A 74 year old male with a history of hypertension, diabetes, hyperlipidemia, presented for an outpatient endoscopy after he was found to have iron deficiency anemia and fecal occult blood positive on a stool sample by his primary care physician. The patient underwent an esophagogastroduodenoscopy (EGD) that revealed multiple angioectasias througho [...]

Gastric Hyperplastic Polyps

admin — Mon, 06 May 2013 10:15:11 +0000

Madhusudhan Sunkavalli, MD, University at Buffalo, Buffalo, NY
Bo Xu, MD, PhD, Roswell Park Cancer Institute, Buffalo, NY
Andrew J. Bain, MD, University at Buffalo, Buffalo, NY, Roswell Park Cancer Institute, Buffalo, NY

Case 1: 67-year-old male underwent EGD for evaluation of iron deficiency anemia, which revealed multiple large polyps in the gastric antrum. He was referred to our center for further evaluation. Video 1: Upper endoscopy showed approximately 15 polyps in the antrum and extending into the pylorus. They were mostly pedunculated and the largest was 25 [...]

Bigelow Rounds presented by Dr Ruma Rajbhandari

admin — Wed, 24 Apr 2013 14:04:27 +0000

Ruma Rajbhandari, MD, Massachusetts General Hospital

Dr Ruma Rajbhandari, GI Fellow at Massachusetts General Hospital, presents two patient cases in Bigelow Rounds at the MGH GI Unit. The presentation was recorded 09 April 2013. [...]

Endoscopic Closure of a Gastropleural Fistula

admin — Mon, 25 Mar 2013 07:30:30 +0000

Antonio Mendoza Ladd, MD, Lenox Hill Hospital
Paresh Shah, MD, Lenox Hill Hospital
Gregory Haber, MD, Lenox Hill Hospital

Step 1: Identification of the fistula. The suture line of the prior sleeve gastrectomy is identified and followed proximally, to a focal area of nodularity with inflammatory pseudopolyps in the anastomotic scar. Moving proximally towards the GE junction, the gastric opening of the fistula is clearly identified in the greater curvature of the stom [...]

Removal of an Internally Migrated Pancreatic Duct Stent

admin — Mon, 25 Feb 2013 11:20:57 +0000

Ara B. Sahakian, MD, Yale University
Harry Aslanian, M.D., Yale University
James Ostroff, MD, University of California, San Francisco
Priya A. Jamidar, MD, Yale University

Pancreatic duct stents are useful in reducing the risk of post-ERCP pancreatitis. Risks of placing pancreatic duct stents include internal migration, difficult or failed placement, and ductal damage. Improper placement of pancreatic duct stents can predispose to migration. Removal of internally migrated pancreatic duct stents can be technically cha [...]

Harry Thomas’ Cases from the Bigelow

admin — Mon, 18 Feb 2013 11:01:21 +0000

Harry J. Thomas, MD, Massachusetts General Hospital

Dr Harry Thomas, GI Fellow at Massachusetts General Hospital, presented clinical cases at Bigelow Rounds. The presentation was recorded 24 July 2012. [...]

Pancreatic Lymphoepithelial Cyst

admin — Mon, 11 Feb 2013 19:46:48 +0000

Sandeep T. Samuel, MD, University at Buffalo, Buffalo, NY
Neil Wilkinson, MD, Roswell Park Cancer Institute, Buffalo, NY
Kanheira Kazunouri, MD, Roswell Park Cancer Institute, Buffalo, NY
Andrew J. Bain, MD, Roswell Park Cancer Institute, Buffalo, NY

A 67-year-old male presented with left upper quadrant abdominal pain of one month duration. A CT scan showed a 3 cm cystic lesion with internal fat content arising from the tail of pancreas. The CA 19-9 level was within normal reference range at 8.4 U/mL. Patient was referred to our institution for further evaluation with endoscopic ultrasound. [...]

Surgical Management of Chronic Ulcerative Colitis

admin — Mon, 11 Feb 2013 11:01:54 +0000

James M. Becker, MD, Massachusetts General Hospital

Dr James Becker of the Department of Surgery at Massachusetts General Hospital delivered Clinical Grand Rounds at the MGH GI Unit on the topic of ulcerative colitis. The presentation was recorded 5 June 2012. [...]

Personalizing therapy for Inflammatory Bowel Disease

admin — Mon, 04 Feb 2013 11:01:25 +0000

Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital

Dr Ashwin Ananthakrishnan, Assistant Professor of Medicine at Harvard Medical School and Massachusetts General Hospital, presented Clinical Grand Rounds of the topic of personalized therapy for IBD. The presentation was recorded 1 May 2012. [...]

Gap Junction Communication and Inflammation in Drug-induced Liver Injury

admin — Mon, 28 Jan 2013 11:01:27 +0000

Suraj J. Patel, PhD, Massachusetts General Hospital

Suraj Patel, PhD, Research Fellow in Surgery, presented Clinical Grand Rounds on the topic of drug-induced liver injury at MGH GI Unit. The presentation was recorded 6 March 2012. [...]

Rational Use of Opioid Analgesics

admin — Tue, 22 Jan 2013 13:01:20 +0000

James P. Rathmell, MD, Beth Israel Deaconess Medical Center, Massachusetts General Hospital

Dr James Rathmell, Vice Chair and Chief of the Division of Pain Medicine at Massachusetts General Hospital presented Clinical Grand Rounds at MGH GI Unit on the topic of opioid analgesics. The presentation was recorded 20 March 2012. [...]

Endoscopic submucosal dissection of a well-differentiated intestinal type intramucosal gastric adenocarcinoma

admin — Tue, 22 Jan 2013 13:01:18 +0000

Sergio Coda, MD, PhD, Imperial College London, UK
Paolo Trentino, MD, University of Rome

This video demonstrates the ESD technique used to remove a type 0-IIa+IIc 15 mm early gastric cancer of the fundus in a 79 year-old male patient. The procedure took place in the operating theatre, under deep sedation, with back-up surgical team available. Preoperative endoscopy included contrast chromoscopy with 0.2% indigo carmine dye together w [...]

Cases from the Bigelow

admin — Tue, 22 Jan 2013 10:01:18 +0000

Jay Luther, MD, Massachusetts General Hospital

Dr Jay Luther, GI Fellow at Massachusetts General Hospital presented clinical patient cases for Bigelow Rounds. The presentation was recorded 23 October 2012. [...]

Revitalizing the Dead Liver

admin — Mon, 21 Jan 2013 15:01:26 +0000

Martin Hertl, M.D., Massachusetts General Hospital

Dr Martin Hertl, Surgical Director of the Liver Transplantation Program at Massachusetts General Hospital presents Clinical Grand Rounds at the MGH GI unit. The presentation was recorded September 4, 2012. [...]

Dilation, Stent Placement, and Electroincision of an Esophageal Stricture

admin — Fri, 21 Dec 2012 15:00:21 +0000

Serag Dredar, MD, Yale University
Harry Aslanian, M.D., Yale University

A 67 yo male presented with dysphagia, 2 months after a distal esophagectomy for esophageal cancer. As shown here, the patient has a tight anastamotic stricture. Multiple staples can be seen adjacent to the stricture. A few of the staples were removed to allow for access to the esophageal lumen. A TTS dilation balloon catheter is just able to tr [...]

Complete Endoscopic Windsock Diverticulotomy Using a Duodenoscope

admin — Mon, 15 Oct 2012 19:30:34 +0000

Sharlene L. D’Souza, MD, University of Michigan
Dejan Micic, MD, University of Michigan
B. Joseph Elmunzer, MD, University of Michigan

A 29-year-old female with no prior medical history was transferred to our facility for evaluation of post-prandial nausea and right upper quadrant abdominal pain. These symptoms had been present for the past three months. She reported emesis of undigested food within five minutes of oral intake, which resulted in the patient being on a liquid-onl [...]

Boerhaave’s syndrome

admin — Fri, 24 Aug 2012 10:40:31 +0000

Jose Alberto Gonzalez-Gonzalez, MD, Centro Regional de Enfermedades Digestivas, UANL, Monterrey, Mexico
Jonas Villareal, MD, Centro Regional de Enfermedades Digestivas, UANL, Monterrey, Mexico
Hector J. Maldonado, MD, Centro Regional de Enfermedades Digestivas, UANL, Monterrey, Mexico

This is the case of 41 year old men with active chronic alcoholism how was admitted to the ER complain nausea and vomiting in multiples occasion during the pass two days. Two hours before to the admission, he started with sever abdominal pain and bright red blood hematemesis. Vital sign upon the arrival were blood pressure 90/60 HR: 110x. Laborat [...]

Cholangioscopic evaluation of a ‘dominant’ stricture in primary sclerosing cholangitis

admin — Thu, 23 Aug 2012 14:51:02 +0000

Shyam Menon, MD, MRCP, University Hospital Aintree
Venkata Lekharaju, MRCP, University Hospital Aintree
Monica Terlizzo, MD, University Hospital Aintree
Richard Sturgess, MD, University Hospital Aintree

A 65-year old man with background primary sclerosing cholangitis (PSC) diagnosed 5 years previously presented with worsening jaundice, pruritus and weight loss. His liver function tests confirmed cholestatic jaundice. His Ca 19-9 levels were raised. Cross-sectional imaging with a CT suggested dilatation of the intrahepatic biliary system. A strictu [...]

Endoscopic gallbladder drainage and lavage using swing-tip catheter and a 20cm Johlin stent

admin — Wed, 23 May 2012 08:28:50 +0000

Martin L. Freeman, M.D., University of Minnesota
Mustafa Tiewala, MD, University of Minnesota

In this video we will show gallbladder drainage in a 44 year old man with widely metastatic appendiceal carcinoma but good functional status, who had bilatereal nephrostomy tubes. He presented with RUQ pain, tenderness, normal LFTs, but CT and ultrasound showing a distended gallbladder with sludge, thus clear evidence of cholecystitis. He was felt [...]