Kondal R. Kyanam Kabir Baig

Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract.

BACKGROUND AND STUDY AIMS The over-the-scope clip (OTSC; Ovesco Endoscopy, Tübingen, Germany) is deployed after suctioning tissue into the cap. The tissue may then be resected endoscopically. The aim of this study was to evaluate the efficacy and safety of the OTSC for the endoscopic resection of gastrointestinal tumors. PATIENTS AND METHODS This was a retrospective, observational cohort study of patients undergoing endoscopic resection of submucosal lesions. RESULTS Eight patients underwent endoscopic resection of neuroendocrine tumors (NETs) of the duodenum (n = 4), rectum (n = 1), or stomach (n = 2), or granular cell tumor (GCT) of the esophagus (n = 1). The mean size of the lesions was 13.4 mm (range 9 - 20 mm). Application of the clip was successful in all patients. A successful endoscopic resection was accomplished in all. A complete resection (R0) was accomplished in 7/8 patients (87.5 %). A full-thickness resection was achieved in 2/8 (25.0 %), one in a patient with a gastric NET and the other in a patient with GCT of the esophagus. There were no complications. CONCLUSIONS This case series suggests that the OTSC system may be a valuable tool for the resection of submucosal lesions, but further prospective and randomized studies are necessary to assess the indications and outcome.

New method of direct percutaneous endoscopic jejunostomy tube placement using balloon-assisted enteroscopy with fluoroscopy

Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful method to provide nutrition to patients with a variety of gastrointestinal (GI) problems. The present study describes a new method of DPEJ using balloon‐assisted‐enteroscopy.

Case series on multimodal endoscopic therapy for gastric antral vascular ectasia, a tertiary center experience

AIM To study and describe patients who underwent treatment for gastric antral vascular ectasia (GAVE) with different endoscopic treatment modalities. METHODS We reviewed patients with GAVE who underwent treatment at University of Alabama at Birmingham between March 1, 2012 and December 31, 2016. Included patients had an endoscopic diagnosis of GAVE with associated upper gastrointestinal bleeding or iron deficiency anemia. RESULTS Seven out of 15 patients had classic watermelon description for GAVE, 1/15 with diffuse/honeycomb pattern and 6/15 with nodular GAVE per EGD description. Seven out of 15 patients required multimodal treatment. Four out of six of patients with endoscopically nodular GAVE required multimodal therapy. Overall, mean pre- and post-treatment hemoglobin (Hb) values were 8.2 ± 0.8 g/dL and 9.7 ± 1.6 g/dL, respectively (P ≤ 0.05). Mean number of packed red blood cells transfusions before and after treatment was 3.8 ± 4.3 and 1.2 ± 1.7 (P ≤ 0.05), respectively. CONCLUSION Patients with nodular variant GAVE required multimodal approach more frequently than non-nodular variants. Patients responded well to multimodal therapy and saw decrease in transfusion rates and increase in Hb concentrations. Our findings suggest a multimodal approach may be beneficial in nodular variant GAVE.

Over-the-scope clip to close bleeding pancreaticoduodenal fistula

re 1. A, CT of the abdomen/pelvis with severe acute pancreatitis, with several peripancreatic gas-containing fluid collections, and periduodenal fluid ctions with air within the collection, suggesting fistula. Decreased pancreatic parenchymal enhancement suggesting pancreatic necrosis; also seen are iple calcifications within the pancreatic head consistent with chronic pancreatitis. B, C, Initial EGD with no bleeding source identified in the esophstomach, or duodenum. B, Normal second part of the duodenum on EGD, with Dobhoff tube visualized. C, Colonoscopic view was also unremarkwith only small internal hemorrhoids visualized. D, E, Repeated EGD after hematochezia revealed a blood clot (D), thought to be overlying the r papilla, at the duodenal sweep. E, Placement of 2 endoclips proximal to the bleeding lesion for further endoscopic versus interventional radiology s. F, EUS view showing no evidence of pancreatic divisum with an anatomically normal pancreatic duct. G, Major and minor papilla visualized on ated endoscopy. The blood clot thought to be overlying the minor papilla was in fact visualized at a separate location. H, Deployment of over-thee “bear claw” clip to close bleeding fistula.

Bleeding at Roux-en-Y jejunojejunal anastomosis after orthotopic liver transplantation

A 14-year-old girl with a medical history of primary sclerosing cholangitis/autoimmune hepatitis overlap syndrome diagnosed at age 2, complicated by decompensated cirrhosis, underwent orthotopic liver transplantation (OLT). During OLT she underwent a standard Roux-en-Y hepaticojejunostomy in which the Roux limb was created by dividing the jejunum downstream from the ligament of Treitz. Twenty-four hours after OLT, she experienced hematochezia and acute anemia, raising concern for a luminal bleed as an adverse event of hepaticojejunostomy formation. She was subsequently referred for double-balloon enteroscopy (Video 1, available online at www.VideoGIE.org). On anterior double-balloon enteroscopy, blood was visualized in the stomach, duodenum, and entire visualized jejunum. The jejunojejunal anastomosis was patent, with healthy-appearing mucosa, and an intact staple line with

Flexible endoscopic management of Zenker’s diverticulum

re 1. A, Barium esophagram revealing ZD and a prominent CP. B, Landmark triad of ZD to the left, a prominent cricopharyngeus (CP bar) in the le, and the esophagus with nasogastric tube to the right. C, Needle-knife used to initially incise through prominent cricopharyngeus.D,Muscle fibers icopharyngeus visible after incision with the needle-knife. E, Ceramic ball insulated tip knife, which allows more controlled cutting, in use. rough-the-scope clips applied at base of diverticulum after cricopharyngeal incision to close any potential defects. G, Barium esophagram after omy revealing a small residual ZD. Intubation was also notably easier after myotomy. ZD, Zenker’s diverticulum; CP, cricopharyngeal muscle.

Translational and clinical perspectives on sphincter of Oddi dysfunction

Sphincter of Oddi dysfunction is a complex pathophysiologic entity that is associated with significant morbidity causing abdominal pain, nausea, and vomiting. The purpose of this review is to describe the anatomy and physiology of the sphincter of Oddi, to understand the pathologic mechanisms thought to be responsible for symptomatology, review recent major studies, explore endoscopic and pharmacologic therapies and their efficacy, and to explore future research avenues.