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Create a Free AccountProcedures - Stent placement
EUS-guided natural orifice transluminal endoscopic surgery for the removal of a toothpick embedded in the liver
A 75-year-old man with diabetic end-stage renal disease requiring hemodialysis presented with 1 week of progressive abdominal pain and fever. Laboratory examination showed an alkaline phosphatase level of 140 IU/L and white blood cell count of 15.7 × 109/L. Noncontrast abdominal CT revealed a 2.9-cm × 3.3-cm air/fluid collection in the left hepatic lobe with a linear foreign body extending from the collection into the duodenum (Fig. 1). An upper endoscopy was performed and was notable for 2 pustular lesions and edema in the second portion of the duodenum (Fig. 2).EUS-guided ileocolonic anastomosis for relief of complete small-bowel obstruction
Small-bowel obstruction (SBO) is typically managed with gastric decompression and intravenous hydration; however, when conservative management fails, operative management is necessary.1 In cases of extrinsic compression from adhesive disease, laparotomy with lysis of adhesions is often required.2 Patients with high-grade obstruction who do not proceed to operative management are at risk for bowel perforation and septic shock from peritonitis.3 However, many patients either fail operative management or are not candidates for surgery because of comorbidities.Transpapillary nasocystic tube placement to allow gallbladder distention for EUS-guided cholecystoduodenostomy
A 39-year-old woman with a history of Crohn’s disease and multiple bowel resections presented with 2.5 months of right upper-quadrant pain. Transabdominal US demonstrated multiple gallstones and cystic duct obstruction. The surgical consultation noted that the patient’s multiple prior operations significantly increased the risk of morbidity with cholecystectomy. The gastroenterology service was consulted for endoscopic management of chronic cholecystitis and cystic duct obstruction (Video 1, available online at www.VideoGIE.org ).Intraperitoneal echoendoscopy for rescue of a gastrojejunal anastomosis
A 74-year-old man with a history of diabetes mellitus, hypertension, and pancreatic adenocarcinoma, who had undergone covered metal biliary stent placement 1 year earlier for relief of biliary obstruction, presented with nausea, vomiting, and progressive intolerance to oral intake over a 1-week period. A CT scan of the abdomen and pelvis demonstrated a distended, fluid-filled stomach due to a gastric outlet obstruction from invasion of the tumor into the adjacent duodenum (Fig. 1). A surgical consultation led to the belief that the perioperative morbidity and mortality would be prohibitively high.EUS-guided gastrojejunostomy for relief of gastric outlet obstruction from a large duodenal hematoma
A 44-year-old man with a history of alcoholic pancreatitis presented with 6 weeks of nausea, vomiting, and inability to tolerate oral intake. He reported a preceding fall while intoxicated, resulting in a blunt-force injury to the abdomen. CT demonstrated a pancreatic pseudocyst and large hematoma compressing the second and third portions of the duodenum with gastric outlet obstruction (GOO) (Fig. 1). Surgical consultation suggested that he was not an operative candidate, and total parenteral nutrition (TPN) was initiated.
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