Endoscope traction technique to facilitate over-the-wire biliary cannulation during EUS-guided rendezvous

Post written by Ahmed Altonbary, MD, FRCP, FESGE, from Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt. We describe the "endoscope traction" technique to facilitate over-the-wire biliary cannulation during EUS-guided rendezvous, an effective salvage technique for failed biliary cannulation during ERCP. Technically challenging steps in this technique include biliary puncture, guidewire manipulation, and biliary cannulation using the …

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

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

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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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 …

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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 …

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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 …

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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 …

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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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