DAVE Project - Gastroenterology

Metabolic and Bariatric Surgery: Today and the Future

admin — Tue, 15 May 2012 13:50:45 +0000

Janey S. Pratt, MD, Harvard Medical School, Massachusetts General Hospital

Dr Janey Pratt, Assistant Professor of Surgery at Harvard Medical School and Massachusetts General Hospital, delivered grand rounds at the MGH GI unit on the topic of weight-loss surgery. The presentation was recorded April 7, 2012. [...]

EUS Guided Biliary Drainage for Distal Biliary Obstruction

admin — Tue, 15 May 2012 12:15:00 +0000

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

Introduction: An 80 yo male was referred for jaundice due to cancer of the pancreatic head resulting in obstruction of the distal common bile duct (CBD). An attempt at ERCP had already been undertaken but failed due to periampullary tumour invasion and ulceration. Informed consent for attempted EUS guided access to the biliary tree was given after [...]

Endoscopic Removal of a Giant Fibrovascular Polyp

admin — Tue, 15 May 2012 11:00:10 +0000

Jennifer E. Jorgensen, MD, University of Michigan
Mahmoud M. Al-Hawary, MD, University of Michigan
Henry D. Appelman, MD, University of Michigan
B. Joseph Elmunzer, MD, University of Michigan

A 61 y/o otherwise healthy man presented to his primary care provider complaining of 2 years of intermittent dysphagia primarily to meat. An esophogram revealed a large polypoid filling defect in the thoracic esophagus and he was referred for an EGD. Upon further questioning, the patient stated that he had intermittently had difficulty breathin [...]

Vanek Polyp

admin — Mon, 14 May 2012 20:05:41 +0000

Gregory Lam, DO, SUNY Downstate Medical Center
Yvette Lam-Tsai, MD, SUNY Downstate Medical Center

A 68 year old African American female with a history of diabetes, hypertension, hyperlipidemia, diverticulosis, and arthritis presented with complaints of palpitations. She was tachycardic on admission with a pulse of 105. Further history revealed she had noted darkened stools 3 weeks prior to presentation. She also complained of occasional naus [...]

Ultraslim Gastroscopy for Wire-Guided Cholangioscopy

admin — Mon, 14 May 2012 12:50:35 +0000

Cetin Karaca, MD, Istanbul University
Bulent Baran, MD, Istanbul University

Cholangioscopy has an increasingly important role in the diagnosis and treatment of biliary and pancreatic diseases. Initiative attempts were made during late 1970s, but due to the technical difficulties the procedure did not find a place in routine endoscopic practice (1,2). Over the past 20 years miniature scopes were designed which pass through [...]

Updated and Evolving Concepts in Gastric Neoplasia

admin — Wed, 07 Mar 2012 11:03:45 +0000

Gregory Y. Lauwers, M.D., Massachusetts General Hospital

Dr Gregory Lauwers, Professor at the Department of Pathology at Harvard Medical School, presented clinical grand rounds for the MGH GI Unit. The presentation was recorded on February 7, 2012. [...]

Risks of therapy in IBD: What can we do to protect our patients?

admin — Fri, 02 Mar 2012 12:03:04 +0000

Garret Cullen, MD, Beth Israel Deaconess Medical Center

Dr Garret Cullen, Assistant Director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center, presented clinical grand rounds at the MGH GI Unit on January 24, 2012. [...]

Cholangioscope-assisted retrieval of a migrated biliary stent

admin — Wed, 15 Feb 2012 09:02:38 +0000

Patrick Yachimski, MD, Vanderbilt University Medical Center

The patient had undergone cholecystectomy for calculous gallbladder disease, followed by ERCP with biliary stent placement. He was referred for endoscopic removal of a proximally migrated biliary stent. Scout film obtained at the time of ERCP showed a 10-French plastic biliary stent predominantly within the left intrahepatic biliary tree. Attemp [...]

Treatment of Bleeding Angioectasia with Hemoclips in the Setting of Coagulopathy

admin — Tue, 14 Feb 2012 16:02:56 +0000

Christian Jackson, MD, Loma Linda VA Medical Center
Matthew Oman, MD, Loma Linda VA Medical Center

An 82-year-old male with a history of coronary artery disease, obesity, and atrial fibrillation on chronic anticoagulation with warfarin presented to the emergency department with melena. He denied any abdominal pain, nausea, vomiting, hematemesis, or lightheadedness. He does have chronic pain and ran out of his acetaminophen/hydrocodone and subs [...]

This Hour Has Seven Days: An Update on Autoimmune Pancreatitis

admin — Thu, 09 Feb 2012 07:02:26 +0000

Brenna C. Bounds, M.D., Harvard Medical School, Massachusetts General Hospital

Dr Brenna Casey Bounds, Assistant Professor at Harvard University Medical School and Massachusetts General Hospital, delivered grand rounds at the MGH GI Unit on the topic of autoimmune pancreatitis. Clinical cases are presented. [...]

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

admin — Wed, 21 Dec 2011 10:12:13 +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 — Mon, 05 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 10:09:31 +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 13:09:28 +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 12:06:37 +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 10:06:26 +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 [...]