Ethan Dubin

A Novel Endoscopic Method to Relieve Food Impaction Using an Inflatable Balloon.

Food impaction in the esophagus is a relatively common medical emergency. Most of these food impactions are relieved spontaneously. But for complete esophageal food impactions or impactions not relieved spontaneously, traditional endoscopic methods like using a Roth net, polypectomy snare, or rat or alligator tooth forceps are used to gently manipulate the food material into the stomach. However, these methods may not work in certain circumstances. We present a case of proximal esophageal food impaction that was relieved using an inflatable balloon after the conventional methods proved unsuccessful.

Pancreatic enlargement in alcoholic pancreatitis : prevalence and natural history

We determined the prevalence and natural history of pancreatic enlargement by abdominal ultrasonography or computed tomography in 72 patients with alcoholic pancreatitis. Pancreatic enlargement was observed in 54 patients (75%); it was diffuse in 28 (52%) and focal in 26 (48%). The focal enlargement was frequently cystic (50%), while the diffuse enlargement was only occasionally cystic (7%). Sequential imaging of the pancreas in 29 patients demonstrated partial to total resolution of pancreatic enlargement in greater than 50% during 6 months of follow-up. Determination of serum amylase and p-isoamylase activity was neither sensitive nor specific for pancreatic enlargement in alcoholic pancreatitis.

EUS-guided colo-enterostomy as a salvage drainage procedure in a high surgical risk patient with small bowel obstruction due to severe ileocolonic anastomotic stricture: a new application of lumen-apposing metal stent (LAMS)

We submit the first case report of a successful EUS-guided transmural LAMS placement to drain the small bowel directly into the transverse colon in a high surgical risk patient with obstruction due to severe anastomotic stricture. We describe our technique for endoscopic colo-enterostomy and are hopeful that this will become a viable option to manage non-operable high-grade distal small bowel obstruction.

A critical evaluation and a search for the ideal colonoscopic preparation.

OBJECTIVES The aim of this study was to evaluate the efficacy of various bowel preparations in accomplishing colonic cleansing for optimal mucosal visualization during colonoscopy. METHODS The study included a cohort of 980 patients who underwent colonoscopy at our endoscopy center within the last 3 years. All of the study patients were subdivided into four groups. Each group included 245 patients, all receiving a different type of bowel preparation. The bowel preparations used in this study included: magnesium citrate (Group I), a combination of oral sodium phosphate (fleets) and powder PEG-3350 (Group II), powder polyethylene glycol-3350 (PEG-3350 powder for Group III), and oral sodium phosphate (fleets for Group IV). A Colon Prep Score (CPS) was devised to compare the quality of the different bowel preparations used. The colonoscopy results from all of these patients were tabulated and analyzed statistically and expressed as mean ± 1 standard deviation. Statistical analysis was performed using a one way ANOVA with Holm-Sidak method for intergroup analysis. RESULTS Group I patients received magnesium citrate and had a mean CPS ± 1 SD of 3.11 ± 0.91. Group II patients (fleets and powder PEG-3350 combination) achieved a CPS of 3.37 ± 1.16. The patients in Group III (powder PEG-3350) actually showed the highest mean CPS of 3.44 ± 1.12. Group IV patients who used oral sodium phosphate alone reached a mean CPS of 3.23 ± 1.01. Group III patients (powder PEG-3350 only) demonstrated a statistically higher CPS (P<0.0006) in colon cleansing as compared to Group I patients (magnesium citrate). Similarly, Group II patients (oral sodium phosphate and powder PEG-3350 combination) also showed improved colon cleansing statistically (P<0.006) as compared to Group I patients (magnesium citrate). CONCLUSIONS Overall, all four colon preparations achieved an average CPS greater than 3.0 indicating clinically adequate colonic cleansing. However, powder PEG-3350 alone and in combination with oral sodium phosphate was observed to be statistically superior to magnesium citrate, when used for colon preparation for colonoscopy.

Multiple biliary stents: a therapeutic option for persistent biliary leak following laparoscopic cholecystectomy.

ment and social life. Acta Endocrinol (Copenh). 1991;125:359–365. 4. Idilman R, De Maria N, Colantoni A, et al. Cirrhosis in Turner’s syndrome: case report and literature review. Eur J Gastroenterol Hepatol. 2000;12:707–709. 5. Roulot D, Degott C, Chazouilleres O, et al. Vascular involvement of the liver in Turner’s syndrome. Hepatology. 2004;39: 239–247. 6. Nataf P, Cacoub P, Dorent R, et al. Results of subtotal pericardiectomy for constrictive pericarditis. Eur J Cardiothorac Surg. 1993; 7:252–255. 7. Zimand S, Benjamin P, Frand M, et al. Constrictive pericarditis presented by generalized edema (anasarca). Isr Med Assoc J. 2000;2:316–317. 8. Ling LH, Oh JK, Schaff HV, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation. 1999;100:1380–1386.