DAVE Project - Gastroenterology

Endoscopic Stent-in-Stent Placement for the Palliation of Malignant Duodenal Obstruction

admin — Wed, 21 Dec 2011 10:56:13 +0000

Jonathan Buscaglia, MD, Stony Brook University Medical Center
Parantap Gupta, MD, Stony Brook University Medical Center

A 56 year old man with malignant duodenal obstruction presents with recurrent nausea and vomiting. The endoscope is not able to be passed through the existing duodenal stent. Both the duodenal stent and the previously placed biliary stent can be seen. A standard biliary extraction balloon is passed through the narrowed lumen of the previously place [...]

Clip-aided biliary cannulation

admin — Thu, 15 Dec 2011 11:12:30 +0000

Shyam Menon, MRCP, University Hospital Aintree
Richard Sturgess, MD, University Hospital Aintree

An 81-year old male presented to his local hospital with multiple episodes of biliary colic and two episodes of cholangitis. Cross-sectional imaging revealed a 20mm common bile duct stone with dilated extra and intra-hepatic bile ducts. Attempted ERCP failed twice due to the presence of a large duodenal diverticulum. At ERCP, we found a large per [...]

Pancreatic Rests

admin — Mon, 12 Dec 2011 11:12:13 +0000

Andrew J. Bain, MD, University of California San Diego
Suresh Pola, MD, University of California San Diego, Veterans Affairs San Diego Medical Center
Thomas Savides, MD, University of California San Diego

A 54 year old female underwent upper endoscopy at an outside facility for evaluation of dyspepsia showing a subepithelial gastric mass. Mucosal biopsies were non-diagnostic. The patient was referred to our center for endoscopic ultrasound and further tissue sampling. Upper endoscopy showed a 1 cm subepithelial mass in the gastric antrum locate [...]

Biliary IPMN (Intraductal Papillary Mucinous Neoplasm) Diagnosed with Cholangioscopy

admin — Tue, 06 Dec 2011 09:12:25 +0000

Raymond Tang, MD, University of California San Diego
Thomas Savides, MD, University of California San Diego

A 62 year-old man was referred for recurrent obstructive jaundice. Cross-sectional imaging revealed dilated biliary system without obvious obstructing lesion. ERCP at an outside facility demonstrated filling defects in a markedly dilated common bile duct. Bile duct balloon sweeps removed large amount of gelatinous and purulent material but no sto [...]

Diagnosis of Acute Appendicitis with granulomatous disease during colonoscopy

admin — Mon, 05 Dec 2011 09:12:07 +0000

Truptesh H. Kothari, MD, Lenox Hill Hospital
David H. Robbins, MD, Lenox Hill Hospital

Patient is a 27 year old female presents to endoscopy suite for colonoscopy for evaluation of rectal bleeding. Patient denies abdominal pain, fever, chills, nausea, vomiting, bowel – bladder complaints.Patient denies history of surgery and family history of GI cancers or polyps. On physical examination, found to be normal with normal vital s [...]

Metastatic Somatostatinoma

admin — Wed, 21 Sep 2011 10:00:31 +0000

Prashant Kedia, MD, Mount Sinai Medical Center
Ron Lee, MD, Mount Sinai Medical Center
Kalpesh Patel, MD, Mount Sinai Medical Center
Michelle Kim, MD, Mount Sinai Medical Center

A 41 year old surgeon presented with several months of epigastric pain. A CT scan was performed which revealed multiple masses in the liver, the largest of which measured approximately 7.4 cm in diameter. Some of these lesions demonstrated high peripheral density suggestive of calcification; no obvious pancreatic mass was noted. A CT guided biop [...]

Intraductal Papillary Mucinous Neoplasm (IPMN) with Malignant Biliary Invasion

admin — Tue, 20 Sep 2011 13:07:28 +0000

Patrick Yachimski, MD, Vanderbilt University Medical Center

The patient is an 84 year old male who had previously been diagnosed with a main duct IPMN involving the pancreatic head. The patient had opted for expectant management in lieu of surgical resection, and had been relatively asymptomatic for 2 years, until presenting with jaundice, cholangitis, and gram negative sepsis. An abdominal CT demonst [...]

Colon Cancer Prevention: EMR of Flat Lesion – SSA

admin — Wed, 15 Jun 2011 12:06:12 +0000

Gottumukkala S. Raju, MD, MD Anderson Cancer Center
Liben Mahometano, MD Anderson Cancer Center
Asif Rashid, MD, PhD, MD Anderson Cancer Center
Patrick Lynch, MD, MD Anderson Cancer Center

Colon cancer prevention series: we would like to share with you endoscopic mucosal resection of a flat lesion in the cecum. Here is a 62 year old man who was recently diagnosed with prostrate cancer. He was referred to us for colonoscopy. He had two large sessile serrated adenomas removed earlier. He came in for removal of additional lesions. In th [...]

Colon Cancer Prevention: Flat Lesion and Endoscopic Mucosal Resection

admin — Fri, 10 Jun 2011 09:40:26 +0000

Gottumukkala S. Raju, MD, MD Anderson Cancer Center
Liben Mahometano , MD Anderson Cancer Center
Asif Rashid, MD, PhD, MD Anderson Cancer Center
Patrick Lynch, MD, MD Anderson Cancer Center

In this colon cancer prevention series, we would like to show you a flat lesion and its removal using endoscopic mucosal resection technique. A 70-year-old man with prior colon cancer resection and negative colonoscopies on several occasions came in for surveillance examination. As you can see here, there is a flat lesion evidenced by a red patch a [...]

How to record and edit endoscopy videos: Equipment set-up

admin — Thu, 09 Jun 2011 12:06:20 +0000

Evan S. Dellon, MD, MPH, University of North Carolina

Overview and objectives This video will review the equipment and set-up needed to record high-quality endoscopic video. At the end of this presentation, you will know the specific equipment needed, how to set-up this equipment for use during a procedure, and how to capture video footage. A schematic of the set-up is shown here. The vid [...]

Management of Complications of Weight Loss Surgery

admin — Mon, 06 Jun 2011 12:06:30 +0000

W. Scott Butsch, MD, Massachusetts General Hospital

Dr W. Scott Butsch, physician in the MGH Weight Center, presented at the clinical fellows' conference at the MGH GI Unit. The topic of was management of complications following weight loss surgery. The presentation was recorded 31 May 2011. [...]

Insulinoma

admin — Thu, 02 Jun 2011 12:06:13 +0000

Charles Chaya, MD, Kaiser Permanente Riverside Medical Center
Albert Ko, MD, Kaiser Permanente Riverside Medical Center
Mark Taira, MD, Kaiser Permanente Riverside Medical Center
Jane Tongson-Ignacio, MD, Southern California Permanente Medical Group Regional Laboratory
Brian S. Lim, MD, Kaiser Permanente Riverside Medical Center

60 year old female presented with episodes of hypoglycemia with glucose in the range of 55 to 63. Her symptoms included night sweats and confusion during the day time for which patient would eat peanut butter with improvement. Symptoms were worse with exercise. Patient was found to have high insulin level of 20 (normal 3 - 11 mU/L). C-peptide [...]

Autoimmune Hepatitis

admin — Wed, 01 Jun 2011 09:00:29 +0000

Lawrence S. Friedman, M.D., Newton-Wellesley Hospital

Dr Lawrence Friedman, Chair of the Department of Medicine at Newton-Wellesley Hospital and Assistant Chief of Medicine at Massachusetts General Hospital presented grand rounds at the MGH GI Unit. The topic was autoimmune hepatitis. The presentation was recorded 31 May 2011. [...]

Precut papillotomy in distal bile duct obstruction

admin — Thu, 26 May 2011 13:05:35 +0000

Shyam Menon, MRCP, University Hospital Aintree
Richard Sturgess, MD, University Hospital Aintree

A 91-year old woman was admitted with painless jaundice, weight loss and Cholestatic symptoms. Imaging revealed dilated intra and extra-hepatic bile ducts down to the level of the ampulla. We were unable to initially obtain selective deep cannulation of the bile duct using a sphincterotome and wire in a standard technique as the ampulla was very fl [...]

Cholangioscopic evaluation of a biliary stricture

admin — Thu, 26 May 2011 12:57:00 +0000

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

A 68-year old man was admitted with weight loss, deep jaundice and Cholestatic liver function tests (LFTs). Cross-sectional imaging revealed dilatation of the intrahepatic ducts. Close inspection revealed a sharp cut-off at the level of the hilum suggestive of a hilar infiltrative process. Moreover, the intrahepatic ducts were not significantly dil [...]

Population-Based Screening and Cascade Testing for Lynch Syndrome: Are We There Yet?

admin — Fri, 06 May 2011 08:05:13 +0000

Vincent W. Yang, MD, PhD, Emory University School of Medicine

Dr Vincent Yang, Director of the Division of Digestive Diseases at Emory University School of Medicine, presented clinical grand rounds at the MGH GI Unit. The topic was screening for Lynch Syndrome (HNPCC). The presentation was recorded 19 April 2011. [...]

EUS Learning Series: Gastric cancer EUS staging

admin — Wed, 27 Apr 2011 07:04:28 +0000

Gottumukkala S. Raju, MD, MD Anderson Cancer Center
Muslim Atiq, MD, MD Anderson Cancer Center
Jeffrey H. Lee, MD, MD Anderson Cancer Center

Staging of gastric cancer. A 73 year old man underwent EGD for gastroesophageal reflux disease. It revealed a 3 cm antral mass; biopsies were positive for cancer. He was referred to our center for tumor staging. It consisted of a CT scan to rule out metastasis and an EUS for locoregional staging. Let us look at the CT scan first. As you can see her [...]

Budesonide Is Effective in Adolescent and Adult Patients With Active Eosinophilic Esophagitis

admin — Tue, 26 Apr 2011 07:04:08 +0000

Sophia Jagroop, MD, Stony Brook University Medical Center

Dr Sophia Jagroop, GI Fellow at Stony Brook University Medical Center, reviewed the recent article from the journal Gastroenterology titled "Budesonide Is Effective in Adolescent and Adult Patients With Active Eosinophilic Esophagitis". The presentation was recorded in April 2011. [...]

Indeterminate Biliary Strictures: Gadgets and Molecular Analysis to Improve Diagnosis

admin — Mon, 25 Apr 2011 08:04:04 +0000

Susana Gonzalez, MD, Columbia University Medical Center

Dr Susana Gonzalez, Interventional Endoscopy Fellow at Columbia University Medical Center, delivered clinical grand rounds at the Massachusetts General Hospital GI unit. The topic was improving diagnosis of indeterminate biliary strictures. The presentation was recorded in March 2011. [...]

Endoscopic Ampullectomy with twin-wire technique

admin — Thu, 21 Apr 2011 07:04:49 +0000

Dr. Quan Wai Leong, Tan Tock Seng Hospital, Singapore

Endoscopic ampullectomy has been considered a high risk procedure associated with a higher complication rate of bleeding, perforation and pancreatitis compared to conventional ERCP. Much effort has been spent on using different technique, equipment and different power settings of the electrosurgical unit in an attempt to minimize complications. T [...]