Farhoud Khosravi

Pancreatic necrosectomy using an automated mechanical endoscopic tissue extraction device

A 66-year-old man with uncontrolled diabetes mellitus and prior cholecystectomy presented to an outside hospital with symptoms of intractable abdominal pain, nausea, and vomiting. He received a diagnosis of acute pancreatitis and was treated conservatively and eventually discharged. He continued to have persistent symptoms and was admitted again. An abdominal CT scan revealed a pancreatic fluid collec-

Sigmoid colon polyp EMR with novel endoscopic morcellator

A 65-year-old woman underwent screening colonoscopy and was found to have a 60-mm polyp that was removed in piecemeal fashion by another gastroenterologist. The initial pathologic examination noted tubular adenoma with high-grade dysplasia. Repeated surveillance colonoscopy 3 months later noted a 20-mm area of residual focus that was draping over a fold. Examination of repeated biopsy specimens taken at that time noted tubular adenoma without high-grade dysplasia or malignancy (Fig. 1A). Owing to risk factors, such as prior high-grade dysplasia and the location and character-

Antegrade cholangiogram via cholecystoduodenostomy in biliary pancreatitis

re 1. A, EUS showing gallbladder wall thickening, with common bile duct dilatation and sludge (arrow). B, Endoscopic view of cholecystoduodemy via lumen-apposing metal stent. C, Presence of a large periampullary diverticulum leading to failure of location of the papillary orifice and ccessful ERCP. D, Antegrade cholangiogram with contrast medium filling the bile duct. E, Expression of contrast medium from papillary orifice. en transcript of the video audio is available online at www.VideoGIE.org.

Giant Brunner’s Gland Hamartoma as a Cause of Iron Deficiency Anemia

Transduodenal resection per hepatobiliary surgery revealed a 3 x 12-cm polyp (Figure 3). Surgical evaluation also revealed ulcerations of the mucosa surrounding the polyp, which were thought to be the cause of his iron deficiency anemia. Pathology revealed Brunner’s gland hyperplasia with secondary polyp formation that extended to the margin. The interface between normal small intestine and the polyp was visible. Both showed an intact unremarkable mucosal surface without inflammation. The transition from small nests of Brunner’s glands and other submucosal elements to a multinodular proliferation composed entirely of closely spaced Brunner’s glands was also noted (Figure 4). On follow-up one month after resection, the patient’s hemoglobin level normalized and he no longer required iron supplementation.

EUS-guided decompression of a large mucinous cyst through an electrocautery-enhanced lumen-apposing metal stent

re 1. A, Endoscopic view revealing extrinsic gastric compression on the cardia of the stomach. B, Coronal CT revealing a large pancreatic cystic lesion extrinsic compression on the lesser curvature. C, Linear EUS view of the mucinous cyst with solid debris. D, Additional ultrasound view of the large lesion with mucinous debris. E, Endoscopic view of LAMS 1 month post-procedure. F, Endosonographic view of ceramic-tipped cautery catheter. G, sonographic view of LAMS deployment within the cystic lesion. H, Gastric view of the cystgastrostomy created via LAMS. I, Mucin expression noted LAMS.