EUS-guided gastrojejunostomy for relief of gastric outlet obstruction from a large duodenal hematoma

Post written by Theodore W. James, MD, from the Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA. We present the first reported use of an EUS-guided gastrojejunostomy for the treatment of gastric outlet obstruction from a large duodenal hematoma. A 44-year-old man with a history of alcoholic pancreatitis presented …

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EUS-guided placement of coils and glue for the management of large bleeding fundic varices

Post written by Victoria Gómez, MD, from the Mayo Clinic, Jacksonville, Florida, USA. We present a case of a 58-year-old woman in whom challenging gastric fundic varices were managed successfully with endoscopic variceal obturation using EUS-guided coil placement with subsequent glue injection. Treatment options were limited in this patient due to radiographic findings of liver …

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Large-caliber metal stent controls entry site bleeding during EUS-guided drainage of walled-off necrosis

Post written by Radhika Chavan, MD, DNB, from the Asian Institute of Gastroenterology, Hyderabad, India. A 35-year-old man, diagnosed with acute necrotizing pancreatitis 7 weeks ago, presented with abdominal pain and fever for 2 weeks. Evaluation showed mild leukocytosis with raised amylase and lipase levels. Endoscopic ultrasound (EUS) showed large walled-off necrosis (WON) with minimal …

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In vivo diagnosis of intraductal papillary mucinous neoplasm with per-oral pancreatoscopy–guided confocal laser endomicroscopy

Post written by Yuki Tanisaka, MD, PhD, from the Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan. Our patient was a 79-year-old man in whom computed tomography indicated expansion of the main pancreatic duct. Endoscopic ultrasound (EUS) showed expansion of the entire pancreatic duct but could not detect the villous protrusions. Endoscopic …

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Endoscopic intra-abdominal rescue therapy of a dislodged EUS-guided hepaticogastrostomy stent

Post written by Johannes Maubach, MD, from the Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. We report a case of an 86-year-old fragile woman who was admitted with painless jaundice and massively congested intrahepatic ducts. An outside MRCP showed a suspicious lesion in the tail of the …

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EUS-directed transgastric ERCP

Post written by Antonio Mendoza Ladd, MD, from the Department of Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA. This is a case of a patient with impending ascending cholangitis secondary to choledocolithiasis in the setting of a Roux-en-Y anatomy. Given her surgical anatomy, we discussed …

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Crossing the minefield: EUS-guided transesophageal biliary rendezvous

Post written by Sundeep Lakhtakia, MD, DM, from the Asian Institute of Gastroenterology, Hyderabad, India. An elderly male presented with obstructive jaundice due to malignant distal biliary obstruction related to pancreatic head mass. There was associated portal vein thrombosis causing portal cavernoma and large esophago-gastric varices along with ascites. Repeated attempts to drain the obstructed …

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