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Create a Free AccountProcedures - Upper endoscopy (EGD)
Anatomical features of duodenal folds: a key feature to consider during endoscopic resection of duodenal neoplasms
Endoscopists should take care not to snare the muscularis propria during EMR and not to damage the muscularis propria during endoscopic submucosal dissection (ESD) of GI lesions. Duodenal ESD is particularly difficult because of the high risk of intraprocedural or delayed perforation.1 Thermal damage to the muscularis propria may cause delayed perforation. Therefore, it is ideal to dissect the submucosa under direct vision to avoid such damage. We have used the pocket-creation method (PCM) for various GI neoplasms, including those in the duodenum, and reduced the frequency of perforation.The pocket-creation method facilitates gastric endoscopic submucosal dissection and overcomes challenging situations
Endoscopic submucosal dissection (ESD) is the criterion standard for resection of gastric superficial tumors. However, the stomach has a wide lumen that makes gastric ESD difficult in some locations. In difficult locations in the stomach, sometimes a distant or a vertical approach toward the muscularis is unavoidable and results in lengthy procedure times, the occurrence of adverse events, and a low-quality resected specimen. Unlike colorectal ESD, changing the patient’s position during the procedure is very difficult during gastric ESD when the patient is under conscious sedation.Hemostasis of an actively bleeding lesion at the ileocecal valve by low-pressure endoscopy using the gel immersion technique
In emergency endoscopy for GI bleeding or colonoscopy without preparation, the visual field can become obscured. The water immersion method is often used, but it is difficult to secure the visual field because the injected water rapidly mixes with blood or stool. Excessive insufflation, especially in the large intestine, may make insertion of the endoscope difficult. In such a situation, gel immersion endoscopy is very effective (Video 1, available online at www.VideoGIE.org ).1A simple method to reposition a dislocated lumen-apposing metal stent during endoscopic necrosectomy
A 62-year-old man presented with epigastric pain 1 year after treatment of severe pancreatitis (Video 1, available online at www.VideoGIE.org ). CT scan showed walled-off necrosis (WON) approximately 10 cm in size (Fig. 1). Laboratory studies revealed an elevated C-reactive protein level of 8.5 mg/dL. The patient underwent EUS-guided drainage of the infected WON using a lumen-apposing metal stent (LAMS) 20 mm in diameter.Underwater reopenable clip closure of mucosal defects after duodenal endoscopic submucosal dissection
Closing mucosal defects after duodenal endoscopic submucosal dissection (ESD) decreases the risk of postoperative adverse events.1 Although various methods for closure have been proposed,2,3 a single reliable and safe method has not yet been established. Herein, we propose the underwater reopenable clip closure (U-REC), a novel technique for closing mucosal defects after duodenal ESD.
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