Cap-assisted snare capture technique for resection of fibrotic large polyps

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Post written by Muhammad Nadeem Yousaf, MD, from the Department of Medicine, Division of Gastroenterology and Hepatology, University of Missouri–Columbia, Columbia, Missouri, USA, and Ahmed Saeed, MD, from the the Department of Medicine, Division of Gastroenterology and Hepatology, University of Missouri–Columbia, and HCA Midwest Health, Kansas City, Kansas, USA. EMR of nonlifting or fibrotic polyps may pose challenges, especially …

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Incomplete mucosal layer excision during EMR: a potential source of recurrent adenoma (with video)

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Post written by David J. Tate, MBBS, MRCP, PhD, from the Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium, and the Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia. This study primarily focuses on identifying incomplete mucosal layer excision during EMR and understanding its role as a potential risk factor for recurrence of adenoma. …

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Detection of residual stones by peroral direct cholangioscopy in patients with intrahepatic stones after hepaticojejunostomy: a prospective study (with video)

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Post written by Kazuyuki Matsumoto, MD, PhD, from Okayama University Hospital, Okayama, Japan. Radiographic confirmation of the presence of stones remains a challenge in the treatment of intrahepatic bile duct stones in patients after hepaticojejunostomy (HJ). Peroral direct cholangioscopy (PDCS) enables direct observation of the bile duct and is useful for detecting and removing residual stones. However, its …

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Endoscopic Braun enteroenterostomy for the management of severe bile acid reflux following Whipple surgery

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Post written by Shailendra Singh, MD, and Ethan M. Cohen, MD, from the Department of Gastroenterology & Hepatology, West Virginia University, Morgantown, West Virginia, USA. We present a case of a 63-year-old woman who underwent a pancreaticoduodenectomy (Whipple procedure) for a rapidly expanding pancreatic head mass. Three years after the surgery, she developed severe persistent nausea and bilious emesis because …

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Establishment of standards for the referral of large nonpedunculated colorectal polyps: an international expert consensus using a modified Delphi process

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Post written by Samir C. Grover, MD, MEd, FRCPC, FASGE, from Scarborough Health Network and the University of Toronto, Toronto, Ontario, Canada. This study aimed to establish consensus-based standards for the referral of large nonpedunculated colorectal polyps (LNPCPs) for endoscopic resection. Given the complexity and risks associated with resecting LNPCPs, especially those exceeding 20 mm, comprehensive and …

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

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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 …

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Novel self-expandable stent–based endobiliary radiofrequency ablation for unresectable malignant biliary obstruction

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Post written by Yubeen Park, MS, Jung-Hoon Park, PhD, and Sang Soo Lee, MD, PhD, from Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Endobiliary radiofrequency ablation (RFA) was introduced as a promising therapeutic option for unresectable malignant biliary obstruction. However, insufficient contact between the traditional catheter-type electrode and bile duct wall because of irregular …

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

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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 …

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EUS-guided hepaticogastrostomy: practical tips and tricks

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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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General anesthesia and/or deep hypnotic state in propofol-based conscious sedation for endoscopy

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Post written by Ala Sharara, MD, AGAF, FACG, FRCP, from the Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon. The target sedation level for endoscopic procedures is conscious sedation. However, patients might progress to deeper levels of sedation, such as deep sedation and general anesthesia. To our knowledge, no study …

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