Upside down in WONderland: EUS-guided upward insertion of a lumen-apposing metal stent via the third portion of the duodenum

Post written by Rintaro Fukuda, MD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, Yousuke Nakai, MD, PhD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, and the Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Tomotaka Saito, MD, PhD, from the Department of Gastroenterology, Graduate …

Continue reading Upside down in WONderland: EUS-guided upward insertion of a lumen-apposing metal stent via the third portion of the duodenum

Towing the stent to manage malignant gastro-entero-colonic fistula and colonic obstruction

Post written by Mayank Goyal, MBBS, and Navtej Buttar, MD, from Mayo Clinic, Rochester, Minnesota, USA. A 51-year-old man presented with an iatrogenic gastro-entero-colonic fistula after incorrect deployment of a colonic stent that was initially intended to bypass a malignant stenosis at the splenic flexure. The stent was uncovered but fortunately migrated. However, the resulting fistula led to …

Continue reading Towing the stent to manage malignant gastro-entero-colonic fistula and colonic obstruction

EUS-guided hepaticogastrostomy: practical tips and tricks

Post written by Kambiz Kadkhodayan, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA, and Shayan Irani, MD, from Virginia Mason Franciscan Health, Seattle, Washington, USA. In recent years, EUS-guided hepaticogastrostomy (EUS-HGS) has gained traction as a reliable and safe method for definitive biliary drainage in patients who cannot undergo traditional transampullary procedures. Here, we highlight key clinical and …

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Disrupted pancreatic duct with pancreaticocutaneous fistula after percutaneous pseudocyst drain: conversion to internal drainage with transgastric stents

Post written by Saeed Ali, MD, from AdventHealth Orlando, Orlando, Florida, USA, and Brian Boulay, MD, MPH, from the Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois, USA. This is an interesting case of a 67-year-old man who developed acute necrotizing pancreatitis followed by a 19-cm pseudocyst with a …

Continue reading Disrupted pancreatic duct with pancreaticocutaneous fistula after percutaneous pseudocyst drain: conversion to internal drainage with transgastric stents

Antireflux mucosectomy as an effective treatment for GERD after laparoscopic sleeve gastrectomy

Post written by Kazuki Yamamoto, MD, PhD, from the Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan. To our knowledge, this study reports the first instance of antireflux mucosectomy (ARMS) successfully treating GERD after laparoscopic sleeve gastrectomy (LSG). Although LSG is the most common bariatric procedure, accounting for up to 60% of global cases, it also …

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Modified submucosal tunneling endoscopic resection for the management of a large leiomyoma in the gastric fundus

Post written by Yasi Xiao, MD, and Dennis Yang, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA. We present a video of a 61-year-old woman with a symptomatic large subepithelial lesion (SEL) in the gastric fundus. This SEL was biopsied on EUS and found to be a leiomyoma. After multidisciplinary discussion with thoracic …

Continue reading Modified submucosal tunneling endoscopic resection for the management of a large leiomyoma in the gastric fundus

Biliary cast syndrome in Roux-en-Y hepaticojejunostomy anatomy

Post written by Erica Park, MD, from the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. We describe a case of a patient who underwent an orthotopic liver transplantation from a donation after circulatory death. Dehiscence of the biliary anastomosis complicated her post-transplant course, requiring return to …

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Peroral endoscopic myotomy with diverticulotomy using a double tunnel technique: finding your way to an elusive lower esophageal sphincter in spastic achalasia and epiphrenic diverticulum

Post written by Maham Hayat, MD, and Dennis Yang, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA. Our case is that of an 86-year-old woman with a history of achalasia and symptomatic epiphrenic diverticulum (ED) who was referred for peroral endoscopic myotomy (POEM) with simultaneous diverticulotomy. Endoscopy revealed a large ED and an …

Continue reading Peroral endoscopic myotomy with diverticulotomy using a double tunnel technique: finding your way to an elusive lower esophageal sphincter in spastic achalasia and epiphrenic diverticulum

Addition of dilute epinephrine to commercially available submucosal lifting agents for cold snare EMR

Post written by William Hirsch, MD, from the Division of Internal Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA, and Mohammad Bilal, MD, from the Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, University of Minnesota. Our video case details the process of adding dilute epinephrine to commercially available submucosa lifting agents. After …

Continue reading Addition of dilute epinephrine to commercially available submucosal lifting agents for cold snare EMR

Successful endoscopic removal of a retained guidewire in the intrahepatic bile duct using a novel tapered sheath dilator

Post written by Rintaro Fukuda, MD, and Naminatsu Takahara, MD, PhD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, and Yousuke Nakai, MD, PhD, from the Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo. Retained guidewire is not a rare adverse event …

Continue reading Successful endoscopic removal of a retained guidewire in the intrahepatic bile duct using a novel tapered sheath dilator