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Create a Free AccountProcedures - Upper endoscopy (EGD)
Peroral endoscopic myotomy using an endoscopic dissector: another novel device in our toolbox
Peroral endoscopic myotomy (POEM) is a safe and effective technique for the management of achalasia and other nonachalasia motility disorders.1 However, it is technically challenging and time consuming with the use of multiple instruments often required for performing various steps associated with the procedure. While the procedural technique has remained homogeneous, various electrosurgical knives continue to evolve to prevent injuries to the surrounding structures and reduce the need for device changes.EUS-directed transgastric ERCP in Roux-en-Y gastric bypass revision of sleeve gastrectomy
EUS-directed transgastric ERCP (EDGE) is an effective approach for the treatment of biliary adverse events of patients who have undergone Roux-en-Y gastric bypass (RYGB).1 Through deployment of a lumen-apposing metal stent (LAMS) from the gastric pouch into the excluded stomach, EDGE allows access to the bypassed stomach and duodenum in patients who have undergone RYGB (Fig. 1). However, patients who have undergone sleeve gastrectomy (SG) who undergo revision to RYGB have limited working space within both the gastric pouch and excluded stomach (Fig. 2), making therapeutic endoscopic procedures such as EDGE technically challenging.Endoscopic through-the-scope suturing
There is growing interest in closure of larger mucosal defects, given the increasing use of endoscopic resection for early GI neoplasia and the advent of submucosal endoscopy, including peroral endoscopic myotomy. Existing closure methods include through-the-scope clips, over-the-scope clips, and over-the-scope suturing. Although over-the-scope clips and over-the-scope suturing allow closure of large defects, both require endoscope removal for device application and may have difficulty in treating lesions in the proximal colon or the small intestine.Zenker’s diverticulum: advancing beyond the tunnel
Zenker’s diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions.No pouch, no problem: successful endoscopic division of a symptomatic cricopharyngeal bar using a modified peroral endoscopic myotomy technique for Zenker’s diverticulum
Cricopharyngeal bars (CPBs) are fibrous thickenings of the cricopharyngeus (CP) muscle that can rarely lead to dysphagia. Established treatment modalities include esophageal dilation, endoscopic botulinum toxin injection, and surgical cricopharyngeal myotomy. There has been no reported experience with peroral endoscopic myotomy (POEM) for symptomatic CPBs.Management of adverse events of EUS-directed transgastric ERCP procedure
Accessing the pancreatobiliary region in patients with a history of Roux-en-Y gastric bypass (RYGB) can be challenging. Traditionally, techniques such as percutaneous biliary drainage, enteroscopy-assisted ERCP, and laparoscopy-assisted ERCP have been used. However, each technique has its limitations. EUS–directed transgastric ERCP (EDGE) using a lumen-apposing metal stent (LAMS) has emerged as a novel endoscopic technique for ERCP in patients who have undergone RYGB. The aim of this case series was to highlight LAMS-related shortcomings and adverse events during the periprocedural period.Lumen-apposing metal stent for the management of intramural hematoma of the GI tract
GI intramural hematomas are uncommon and usually occur in the esophagus or the duodenum, and in rare cases they occur in the stomach.1 The most common cause is blunt abdominal trauma; other causes include endoscopic interventions, peptic ulcer disease, and pancreatitis; in very rare cases they can occur spontaneously in patients receiving oral anticoagulants.2,3 We present the management of 2 cases of gastric and duodenal intramural hematomas by the use of lumen-apposing metal stents (LAMSs).Endoscopic resection of gastric lipoma with a hybrid technique of unroofing and loop ligation
A 53-year-old woman presented with symptoms of nausea and vomiting. CT demonstrated a well-circumscribed 4-cm submucosal mass of fatty density. EUS revealed a homogeneous, hyperechoic, round mass in the submucosal layer of the gastric antrum consistent with a lipoma causing gastric outlet obstruction. Endoscopic resection was attempted, starting with lifting of the mucosal layer by the injection of diluted epinephrine mixed with methylene blue and hydroxyethyl starch (Video 1, available online at www.VideoGIE.org ).Demonstration of transoral gastric outlet reduction: 2-fold running suture technique
Weight regain after Roux-en-Y gastric bypass (RYGB) is common. This is partially attributable to dilatation of the gastrojejunostomy (GJ), which diminishes the restrictive capacity of the RYGB. Endoscopic revision of a dilatated GJ, called transoral outlet reduction (TORe), has been proved effective and allows patients to avoid reoperation. A 43-year-old woman who had undergone gastric bypass 3 years previously regained 40% of her lost weight, lost postprandial satiety, and had symptoms of dumping syndrome.
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