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Create a Free AccountProcedures - Upper endoscopy (EGD)
Ampullary cyst with papillary orifice distal to bulge: Not always a choledochocele!
A 9-year-old girl presented with recurrent episodes of epigastric pain for the past 3 months. Investigations suggested recurrent acute pancreatitis with significantly elevated amylase and lipase levels on several occasions. Contrast-enhanced CT of the abdomen revealed a 3.1- × 1.8- × 3.9-cm thick-walled nonenhancing cystic lesion along the third part of the duodenum (Fig. 1). MRCP revealed a cyst communicating with the common biliopancreatic channel (Fig. 2). A side-viewing examination using a duodenoscope (Olympus TJF Q180V, Olympus Corp, Tokyo, Japan) revealed a smooth extrinsic bulge extending from the second to the third part of the duodenum on the medial wall.Red dichromatic imaging in peroral endoscopic myotomy: a novel image-enhancing technique
A 40-year-old man presented with a 1-year history of difficulty in swallowing liquids and solids. His Eckhart’s score was 6 of 12. EGD showed dilated esophagus with liquid stasis and mild resistance noted across the gastroesophageal junction. Esophageal manometry showed elevated integrated relaxation pressure with panesophageal pressurization (achalasia cardia type II). Peroral endoscopic myotomy (POEM) was planned and was performed using the novel Evis X1 endoscopy (Olympus Corporation, Tokyo, Japan) system.Endoscopic closure of jejunal perforation in altered anatomy using a detachable endoloop
A 73-year-old man presented with progressive dysphagia and weight loss. Endoscopy showed an ulceroproliferative lesion involving the gastroesophageal junction extending into the fundus and cardia of the stomach. A biopsy sample from the lesion showed moderately differentiated adenocarcinoma. Positron emission tomography showed a gastroesophageal junction growth with no activity in the lymph nodes and no distant metastasis. He underwent total gastrectomy with regional lymphadenectomy (D1 gastrectomy) and intrathoracic esophagojejunostomy with Roux-en-Y jejunojejunal anastomosis.Peroral endoscopic myectomy: a novel thought to reduce recurrence after previous failed myotomy
A 45-year-old man presented with a history of dysphagia and regurgitation for 8 years. He was diagnosed with type II achalasia cardia and underwent Heller’s myotomy without fundoplication 4 years earlier. The results of the present evaluation, including symptom analysis, EGD, timed barium esophagogram, and esophageal manometry, suggested a relapse. Treatment options were discussed, and peroral endoscopic myotomy (POEM) was performed. The posterior route (5 o’clock) was chosen for POEM to avoid possible submucosal fibrosis along the anterior route.Luminal and extraluminal bleeding during EUS-guided double-balloon–occluded gastrojejunostomy bypass in benign gastric outlet obstruction with portal hypertension
A 45-year-old man with longstanding idiopathic chronic pancreatitis and splenic venous thrombosis presented with postprandial vomiting and abdominal fullness 10 months earlier. He received a diagnosis of duodenal narrowing (D1-D2 junction) (Fig. 1) and underwent several sessions of endoscopic balloon dilation, with an ill-sustained response. Surgery was attempted elsewhere; however, gastrojejunostomy was not done because of extensive perigastric collaterals. His laboratory evaluation showed moderate anemia (hemoglobin 10 gm/dL), platelets 1.2 lakhs/mm3, prothrombin time 17 seconds (international normalized ratio 1.28) and normal liver function test results, serum amylase levels, and lipase levels.Per-oral endoscopic myotomy with endoscopic septum division in a case of achalasia with large epiphrenic diverticulum
A 75-year-old man presented to our institution with symptoms of dysphagia and regurgitation. Evaluation with EGD, barium swallow, and esophageal manometry revealed achalasia cardia with a large esophageal epiphrenic diverticulum (EED) (Figs. 1 and 2). Endoscopic myotomy was performed in this case (Video 1, available online at www.VideoGIE.org ).
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