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Emergent endoscopic submucosal dissection for a polypoid fibroadipose tumor accidentally disgorged from the mouth: an organ-preserving minimally invasive treatment
A 74-year-old woman presented with dysphagia. EGD at a previous hospital showed a giant pedunculated polyp from the entrance of the esophagus to the esophagogastric junction. She was referred to our hospital for treatment. On EGD, the polyp was covered with normal epithelium with a swollen and ulcerated head, measuring 17 cm in length. A CT scan revealed an intraluminal tumor in the esophagus with low density and no findings of metastasis (Fig. 1A). Positron emission tomography–CT revealed a highly concentrated area in the esophagus (Fig. 1B).Wide-field ESD for Barrett's adenocarcinoma at the gastroesophageal junction: technical approaches to facilitate en bloc R0 resection
Endoscopic submucosal dissection (ESD) for Barrett's esophagus (BE) neoplasia is associated with high en bloc resection and an acceptable safety profile but with suboptimal curability rates (range, 56%-59%).1 Two large Western studies showed that low R0 resection rates resulted from the high rate of positive lateral margins in ESD specimens (range, 82%-86%), which prompted either salvage ESD or additional surgical treatment.2,3 A U.S. multicenter ESD study found positive lateral margins in up to 70% of Barrett's adenocarcinoma (BA) at the gastroesophageal junction (GEJ) because of the increased technical complexity, poor maneuverability, and difficulty in evaluating the lesion’s margin.Pancreatoscopy-guided retrieval of a migrated pancreatic duct stent
A 26-year-old woman presented to an outside hospital with symptomatic cholelithiasis and underwent a laparoscopic cholecystectomy that was complicated by bile leak and intra-abdominal fluid collections. She underwent intraabdominal drain placement and an ERCP with biliary sphincterotomy and biliary stent placement. The ERCP was technically challenging and required a prophylactic pancreatic duct (PD) stent that was complicated by upstream migration and was unable to be retrieved. She was referred to our center for stent retrieval.EUS–guided choledochoduodenostomy using a lumen-apposing metal stent in a patient with preexisting duodenal stent and ascites
Endoscopic retrograde cholangiopancreatography in patients with a pre-existing duodenal stent is technically challenging with a low success rate.1 EUS-guided biliary drainage has emerged as a promising technique for patients with malignant biliary obstruction when conventional ERCP fails. Although combined placement of self-expanding metal biliary and duodenal stents can be performed for patients with simultaneous biliary and duodenal obstruction, reports on transduodenal EUS-guided biliary drainage in patients with an existing duodenal metal stent are limited.Use of a novel dual-action clip for closure of complex endoscopic resection defects
While there continues to be debate surrounding indications for closure, use of clips following endoscopic mucosal resection of large nonpedunculated polyps has been found to reduce risk of postprocedural bleeding,1-3 and clinically has also been performed to reduce risk of perforation because of muscularis propria injuries. While standard clips are effective for closure of 2- to 3-cm endoscopic mucosal resection sites in the colon, closure of endoscopic submucosal dissection (ESD) wounds is more technically challenging as the deeper dissection plane in ESD tends to result in a larger separation between the wound edges.Point blank: an endoscopic retrieval of an extraluminal bullet
A 36-year-old man with no medical history presented with multiple gunshot wounds to the right neck, left axilla, and pelvis. An entry wound in the right buttocks was noted without a corresponding exit wound. A CT scan identified the bullet near the rectum, and a leak from an administered barium enema further demonstrated the location. (Figs. 1 and 2) A laparoscopic diverting colostomy was performed, and advanced endoscopy was consulted for retrieval of the bullet for ballistics and closure of the subsequent rectal defect.
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