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Create a Free AccountAnatomy - Stomach
Endoscopically directed single-port intragastric fundoplication, sleeve gastroplasty, and myotomy: a preclinical study in a porcine model
The progress of endoscopic therapy in the upper GI tract is limited by the size of the endoscope working channel and by the need to achieve triangulation for instrumentation. A novel transgastric trocar (Endoscopic Trans-Abdominal Gastric Surgery System [Endo-TAGSS, LLC, Shawnee, Kansas, USA]; Kansas City, Mo, USA) has been developed to allow intraluminal therapy using a combined endoscopic and laparoscopic approach (Fig. 1).1,2 The device, not yet Food and Drug Administration approved, is deployed under endoscopic vision with a technique similar to a pull PEG (Fig. 2), and it has been shown to be safe in a preclinical study that evaluated tract closure upon trocar withdrawal.Division of a long-term symptomatic tissue bridge for reversal of endoscopic sleeve gastroplasty
Endoscopic sleeve gastroplasty (ESG) induces weight loss through delayed gastric emptying through gastric remodeling.1 In the long term, this commonly manifests as tissue bridges seen on follow-up endoscopy.2,3 ESG’s clinical efficacy, long durability for weight loss,4 and minimal rate of severe adverse events5 have led to widespread adoption. Although “redo” ESG appears safe and effective,6 reversibility is not well described and is limited to the acute setting. There is a risk that cutting sutures acutely may result in microperforations that put a patient at risk for leak, perigastric fluid collection, abscess, and bleeding.Step-by-step instruction: using an endoscopic tack and suture device for gastrointestinal defect closure
Closure of mucosal and full-thickness defects in flexible endoscopy has become a major concern in interventional endoscopy.1 Multiple closure devices and techniques have been developed in the past years.2-6 However, the closure of large (>30 mm) tissue defects remains challenging, and over-the-scope clips and endoscopic suturing require removal of the endoscope for preparation of the device, which is not optimal, particularly for right-sided colon lesions.Endoscopic suturing of a jejunal feeding tube extension to prevent recurrent gastric coiling
Since the technique was developed in the 1980s, percutaneous endoscopic gastrostomy (PEG) has become the method of choice for long-term enteral nutrition in the United States.1,2 Over 200,000 PEG placements occur yearly in the United States alone.3 Although PEG placement is generally safe, adverse events may arise in the periprocedural time frame.1 Delayed adverse events may also occur in association with PEG use and wound care after the tract has matured.1,2 Some adverse events associated with PEG use include peristomal pain, infection, peristomal bleeding, and GI bleeding or ulceration.Laparoscopic hernia repair and fundoplication with endoscopic sleeve gastroplasty for complex hernia and GERD management in morbid obesity
Symptomatic hiatal hernia (HH) and gastroesophageal reflux disease (GERD) pose a unique medical and surgical challenge in the context of morbid obesity. On one hand, morbid obesity is a strong risk factor for GERD and HH1,2 as a result of increased intra-abdominal pressure and ineffective lower esophageal sphincter.3 On the other hand, management of HH and GERD in morbid obesity is challenging because of the high risk of hernia recurrence after conventional surgical repair.4 Therefore, an optimal solution for HH and GERD in morbid obesity is one that would provide durable hernia repair and weight loss.Every trick in the book: EUS angiotherapy for management of refractory bleeding secondary to a complicated duodenal ulcer in a patient with Roux-en-Y gastric bypass
A 76-year-old man with a history of Roux-en-Y gastric bypass (RYGB) and a prior perforated duodenal ulcer presented to our emergency department with melena. An urgent EGD did not identify a source of bleeding in the esophagus, gastric pouch, gastrojejunostomy, or examined portion of the Roux limb.Endoscopic reversal of Roux-en-Y anatomy for the treatment of recurrent marginal ulceration
Marginal ulceration is one of the most common adverse events after Roux-en-Y gastric bypass (RYGB). The incidence rate of marginal ulcer may be as high as 7%.1-3 Antisecretory therapy is the first-line treatment. However, more than one-third of patients undergo surgical revision for intractable ulcers.4,5 The surgical outcome is excellent overall, except for smokers.5,6 Smokers with intractable marginal ulcer pose an extreme management challenge to clinicians. In this video (Video 1, available online at www.VideoGIE.org ), we describe an active-smoker patient with recurrent and intractable marginal ulcer despite multiple surgical revisions and use of maximal medical therapy who was successfully treated with endoscopic reversal of RYGB.Step-by-step use of hemostatic powder: treatment of a bleeding GI stromal tumor
Hemostatic powder (Hemospray; Cook Medical, Winston-Salem, NC, USA) was recently granted clearance for clinical use by the U.S. Food and Drug Administration for endoscopic therapy of nonvariceal GI hemorrhage (Fig. 1). This device has been in use internationally for more than 5 years, since it became available in 2011, and has been used in more than 70,000 procedures.1 The powder is an inert, nontoxic material called bentonite, and it is aerosolized with the use of a carbon dioxide canister to deliver the powder through a 7F or 10F delivery catheter.
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