Videos

Intussusception represents the telescoping of a proximal segment of the GI tract (intussusceptum) into the lumen of an adjacent distal segment (intussuscipiens).

A 75-year-old woman experienced nausea 7 months prior and had lost 9 kg over 3 months.

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.

Endoscopic hemostasis is an essential skill for endoscopists and has been the first-line treatment.

Endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) has been widely performed.

Periampullary perforation has a high mortality rate.

Endoscopic submucosal dissection (ESD) allows for en bloc resection of various lesions of the GI tract.

Accessing the bypassed portion of the stomach and small bowel for endoscopic interventions in Roux-en-Y gastric bypass (RYGB) is challenging.

Endoscopic adventitial dissection (EAD) is a novel resection technique that involves dissection in the “fourth space,” the space between the outer longitudinal muscle and the tunica adventitia of the rectum.

EUS-guided hepaticogastrostomy (EUS-HG) provides endoscopic biliary drainage when conventional techniques are not feasible.

Endoscopy in infants and children requires different equipment because of the difference in size and weight as compared to adults.

EndoClot Polysaccharide Hemostatic System (EndoClot PHS; Micro-Tech Europe, Dusseldorf, Germany) is a starch-derived compound that consists of biocompatible absorbable hemostatic polysaccharides that absorb water when in contact with blood or liquids, creating a gelled matrix over the bleeding lesion.

The X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery, Austin, Tex, USA) is a novel through-the-scope suture-based device approved for tissue approximation of mucosal defects. 

A 56-year-old man presented with painless jaundice. An outside CT scan reported a pancreatic head mass.

Peroral endoscopic myotomy (POEM) is a safe and effective technique for the management of achalasia and other nonachalasia motility disorders.

GI stromal tumors (GISTs) typically arise from the muscularis propria layer and are commonly seen in the stomach, although they can occur anywhere along the GI tract.

We share here the case of a 67-year-old man who presented to the emergency department for evaluation of bloating, chills, and dyspepsia for 2 weeks.

Direct peroral cholangioscopy (DPOC) is a valuable diagnostic and therapeutic tool for various biliary disorders because it allows direct endoscopic visualization of biliary lumen and mucosal abnormalities. 

GI bleeding because of peptic ulcer disease is a well-described entity in its diagnosis and management.

As various devices and techniques emerge, colorectal endoscopic submucosal dissection (ESD) has become a relatively safe procedure despite the anatomical difficulty.

A 67-year-old man with a history of total gastrectomy followed by Roux-en-Y esophagojejunostomy reconstruction in the setting of gastric adenocarcinoma presented with right-upper-quadrant pain and an abnormal liver function test (LFT) (aspartate aminotransferase 389, alanine aminotransferase 273, alkaline phosphatase 297, total bilirubin 8.70).

With the advancements in endoscopic resection techniques, subepithelial tumors (SETs) can be removed by transnatural orifice endoscopy with minimal invasiveness.

Intraductal papillary mucinous neoplasms of the pancreas (IPMNs) are increasingly diagnosed tumors that are characterized by endoluminal papillary projections of mucin-producing ductal epithelium, leading to a dilatation of the ducts it develops within.

Dropped gallstones (DGS) are unable to be retrieved in 2% of cholecystectomy cases.

EUS-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMSs) has emerged as a safe, minimally invasive modality for the treatment of gastric outlet obstruction (GOO).

Gastrointestinal stromal tumor (GIST) is the most common type of subepithelial lesion (SEL) in the stomach. Management of gastric GISTs varies by size.

A 58-year-old man was coincidentally found to have a duodenal subepithelial lesion in the bulb. Endoscopic ultrasonography revealed a 20-mm anechoic lesion with suspicious echogenic content or a hypoechoic lesion from the muscular propria.

The use of esophageal self-expanding metal stents (SEMSs) has been shown to be advantageous in the setting of malignant dysphagia; they are commonly used for esophageal obstruction and fistulas. 

Endoscopic bariatric therapies provide an effective and minimally invasive approach to obesity that augments the available treatment options beyond surgery, medication, and lifestyle modifications. 

Periampullary diverticulum is a common anatomical alteration around the papilla (6%-31% of native papillae). Its prevalence increases with age, with reported rates as high as 65% in older people.

Endoscopic submucosal dissection (ESD) provides an endoscopic treatment option for esophageal cancers limited to the mucosa and submucosa. However, ESD is high-risk in patients with cirrhosis, owing to associated coagulopathy, thrombocytopenia, and portal hypertension, which increases risk for bleeding and life-threatening decompensation. Particularly troublesome in esophageal ESD are esophageal varices.

Mid-gut exploration is achieved with video-capsule endoscopy  and device-assisted enteroscopy , including motorized spiral enteroscopy. 

Gastrointestinal bleeding is a common emergent condition, accounting for 7% to 8% of acute medical admissions. In the United States, upper GI bleeding (UGIB) leads to an average of 300,000 admissions per year and has a mortality rate that ranges from 2% to 15%.

Acute necrotizing pancreatitis (ANP) can sometimes be complicated by fistulization into the gut because of inflammatory infiltration

The formation of an intestinal stoma for fecal diversion is one of the most frequent interventions for the palliation in intestinal obstruction from colon cancer in inoperable patients. 

A case of an RYGB patient requiring multiple EDGI 

Dysphagia is a common complaint for patients after radiation therapy for head and neck cancer.

A 61-year-old woman with a history notable for a Roux-en-Y gastric bypass (RYGB) presented to the emergency department (ED) with abdominal pain. 

We present a case of a 77-year-old man who underwent endoscopic submucosal dissection of a tumor in the upper esophageal sphincter and piriform sinus for a poorly differentiated squamous cell carcinoma. 

Esophageal stents are used to relieve obstruction in diverse benign and malignant esophageal conditions. 

Defect closure after EMR or endoscopic submucosal dissection (ESD) has been a topic of interest in the last few decades with advances in minimally invasive endoscopic techniques. 

Pancreatic duct stone is a common adverse event associated with chronic pancreatitis. Asymptomatic pancreatic stones can be followed-up by observation, although some cases with severe symptoms require radical treatment, including extracorporeal shock wave lithotripsy, electrohydraulic lithotripsy (EHL), and surgical treatment.

Endoscopic mucosal resection and endoscopic submucosal dissection (ESD) are well-established treatment methods for resection of precancerous gastric lesions and early gastric cancers.

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, and clinically has also been performed to reduce risk of perforation because of muscularis propria injuries.

The incidence of solitary gastric hamartomatous polyps (SGHPs) is extremely low, with fewer than 12 cases reported in the literature.

Endoscopic ultrasound–guided gastrojejunostomy (EUS-GJ) is an alternative to endoscopic stent placement alone and surgical gastrojejunostomy for the management of gastric outlet obstruction (GOO).

Adverse events are rare after bariatric surgery; however, leaks can lead to high morbidity. A large population study demonstrated a rare need for endoscopic management, most commonly endoluminal stent therapy.

Duodenal cavernous hemangiomas are rare; however, when they occur, they may require hemostasis. Hemangiomas are classified into cavernous, capillary, or mixed tumors; the cavernous type is the most common.

Endoscopic retrograde cholangiopancreatography in patients with a pre-existing duodenal stent is technically challenging with a low success rate.

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.

A 29-year-old woman with psychiatric history and multiple foreign body ingestions presented with a 1-day history of moderate to severe nonradiating central abdominal pain.

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%).

Third space endoscopy, also known as submucosal endoscopy, has continued to evolve and expand as a minimally invasive alternative to surgery for the management of various GI diseases.

The current management for intervention in necrotizing pancreatitis consists of a step-up approach with percutaneous drainage as the first choice for infected necrotic collections that are not in contact with the stomach or the duodenum wall.

Endoscopic ultrasound guided gallbladder drainage (EUS-GB) is increasingly being used for patients who cannot undergo a cholecystectomy.

Endoscopic submucosal dissection (ESD) has become a standard approach for treating superficial GI neoplasia, but its adoption remains limited because of its steep learning curve and extensive resource utilization when performed by endoscopists in the earlier stages of the ESD learning curve.

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.

Endoscopic ultrasound–directed transenteric ERCP (EDEE) has recently been described as a safe, effective procedure to obtain biliary access in patients with Roux-en-Y anatomy.

The field of endohepatology has been evolving recently with multiple studies describing the success and safety of EUS-guided liver biopsy (EUS-LB) in obtaining liver parenchymal tissue. 

Zenker’s diverticulum (ZD) is the most common diverticular disease found in the pharyngo-esophageal region. Zenker’s peroral endoscopic myotomy (Z-POEM) has been used incrementally for ZD with good efficacy and safety.

Microsurface patterns of the gastric mucosa can be observed using magnifying narrow-band imaging (M-NBI). However, the efficacy of M-NBI at low-magnification (LM-NBI) screening for detecting small gastric neoplasms is unclear.

Situs inversus totalis (SIT) is the rare occurrence of a mirror image reversal of the entire internal visceral anatomy with a reported incidence of 1 out of 8000 to 1 out of 25,000.

The radial incision and cutting (RIC) method is known as an effective technique for refractory esophageal stricture. Until now, RIC procedures have mostly been performed using normal-caliber endoscopes. 

We present a case of a 45-year-old woman with decompensated alcoholic cirrhosis with portal hypertension, esophageal and gastric varices, loculated ascites, and large intra-abdominal and pelvic abscesses with multiple percutaneous drainage procedures as well as chronic alcoholic pancreatitis complicated by splenic pseudoaneurysm.

A 54-year-old man with a history of prior vertical sleeve gastrectomy underwent esophagogastrectomy for curative intent of invasive adenocarcinoma arising in gastroesophageal junctional mucosa in the background of Barrett’s esophagus.

Endoscopic ultrasound–guided fine-needle biopsy (EUS-FNB) is a minimally invasive procedure commonly used for diagnostic purposes. Because of the accuracy and safety of EUS, both intraluminal and extraluminal lesions can be sampled. Traditional methods of cardiac biopsy, typically through an endovascular approach, are well established

Superficial nonampullary duodenal epithelial tumors are rare, and the establishment of optimized strategies for their treatment is an area of active investigation.  Endoscopic submucosal dissection (ESD) for superficial nonampullary duodenal epithelial tumors poses the risk of major adverse events (AEs), including a high rate of bleeding, intraoperative perforation, and delayed perforation.

GERD is one of the most prevalent digestive diseases, involving approximately 1 in 5 within the United States.  Medical therapy and lifestyle modifications are highly effective for most patients with GERD. Despite this, refractory GERD affects 30% to 45% of patients.

Endoscopic submucosal dissection (ESD) of early gastric cancer located in the fornix is challenging because the lesion is difficult to approach. The lesion in the fornix, especially on the greater curvature side or the anterior wall side, tends to face vertically in the left lateral position (LLP) when in close proximity.

A 75-year-old woman with no medical history presented to her previous physician complaining of weight loss. The patient was referred to our hospital after abdominal ultrasonography revealed a gallbladder lesion. There was irregular thickening of the gallbladder wall on a contrast-enhanced CT scan and multiple broad-based polyps on EUS.

A 56-year-old man was transferred from an outside hospital for management of gastric outlet obstruction. His medical history was significant for metastatic duodenal adenocarcinoma, status postpartial gastrectomy, and duodenectomy with Roux-en-Y GJ. Endoscopy done at the outside hospital revealed an ulcerated stricture at the gastrojejunal anastomosis, with biopsies confirming recurrent adenocarcinoma.

A 38-year-old otherwise healthy man presented with substernal chest pain after self-induced vomiting while attempting to resolve a food impaction. A chest CT scan showed a complex heterogenous air and fluid-filled mediastinal collection suggestive of esophageal rupture.

Small-bowel strictures can present with variable patterns of obstructive symptoms. Determining the etiology can guide the appropriate management. Anastomotic or postsurgical causes from open abdominal surgeries can increase the risk of occurrence. In the setting of long, complex strictures, surgery is the mainstay of treatment.

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) can be performed by either first injecting the contrast medium or inserting the guidewire.

Gastrointestinal stromal tumors (GISTs) greater than 2 cm are considered for resection. Those with muscularis propria (MP) involvement, as seen on endoscopic ultrasound and/or radiology, require full-thickness resection (FTR), surgery, or a combined laparoscopic/endoscopic approach.

Cystic paraduodenal pancreatitis is part of a spectrum of diseases, collectively gathered under the term “paraduodenal pancreatitis,” which involves the area between the duodenum, the pancreatic head, and the common bile duct.

Dieulafoy’s lesion (DL) is an uncommon but potentially life-threatening condition, which can result in sudden, massive gastrointestinal bleeding.

The introduction of population-based screening has resulted in an increased incidence of early-invasive (T1) rectal cancer.

Postsurgical fluid collections (PSFCs) can be a marked source of morbidity for patients, but advances in therapeutic endoscopy have allowed for endoscopic modalities of drainage to become more accessible.

Endoscopic ultrasound–guided hepaticogastrostomy (EUS-HGS) is a therapeutic biliary drainage procedure that can be utilized as an alternative procedure in patients who fail conventional ERCP and have sufficiently dilated left-sided biliary ducts.

A 40-year-old otherwise healthy woman with persistent upper abdominal pain was found to have a 3-cm subepithelial lesion in the prepyloric area and was referred to our center.

Managing outlet stenosis in patients who have undergone vertical banded gastroplasty (VBG) can be challenging.

Magnet ingestion has recently increased among children. Multiple magnets can lead to serious adverse events owing to pressure necrosis of trapped bowel wall; therefore, urgent removal of the magnet is recommended.

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). 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.

ERCP with balloon dilation and placement of multiple plastic stents or covered metal stents for distal biliary strictures has been established as the standard of care in the management of benign biliary strictures.

The X-Tack endoscopic HeliX tacking system (Apollo Endosurgery, Austin, Tex, USA) has recently been approved by the Food and Drug Administration and is slowly gaining popularity for the closure of large tissue defects.

In recent years, endoscopic submucosal dissection (ESD) has been applied for duodenal tumors. The advantage of en bloc excision in ESD is that it allows precise pathological examination. For this reason, it is important to ensure that the resected specimen is collected. However, there is no report on the collection method for duodenal specimens resected by ESD.

We report the case of a 57-year-old woman with multiple endocrine neoplasia type 1 who was referred to us because of the presence of a 15-mm subepithelial lesion in the descendent duodenum.

Significant undernutrition is reported in 13% to 52% of children with neurodevelopmental disabilities (NPDC). Oropharyngeal dysphagia (90%), gastroesophageal reflux (50%-75%), delayed gastric emptying (67%), and/or ineffective esophageal peristalsis (61%) are associated with undernutrition.

In recent years, interventional EUS has opened new doors for the management of biliary diseases that would otherwise not be amenable to traditional endoscopic methods.

Surgical/laparoscopic appendectomy requires abdominal wall incisions/punctures that can subsequently cause hernias, pain, and delayed return to work and regular physical activity after surgical/laparoscopic removal of the appendix.

Postcholecystectomy biliary stricture can be treated with endoscopic or percutaneous treatments. However, these conventional methods are not feasible if a guidewire cannot be passed through the stricture.

Endoscopic suturing is a technique that can be applied to several disease processes, such as repair of fistulae or perforations, endoluminal stent anchoring, and for endobariatric procedures. We describe a case of suturing to repair an obstructing Zenker's diverticulum.

Endoscopic papillectomy is a minimally invasive procedure for duodenal papillary tumors. However, it is often associated with adverse events, such as postprocedural pancreatitis, bleeding, and duodenal perforation. Although postprocedural pancreatitis is a major problem, the placement of a pancreatic plastic stent (p-PS) can reduce the risk of pancreatitis.

Endoscopic resection is a well-established modality for the minimally invasive treatment of superficial lesions throughout the colon and rectum. Although EMR and endoscopic submucosal dissection (ESD) provide excellent results, they have limited efficacy in certain situations, such as deeper lesions and lesions with dense submucosal fibrosis. In these situations, endoscopic full-thickness resection (EFTR) provides an alternative endoscopic resection modality, potentially sparing patients from surgical resection.

Uncovered metal biliary stents have often been employed for malignant biliary strictures, and meta-analyses have shown decreased rates of stent migration compared to covered stents and prolonged patency compared to plastic stents.

Endoscopic resection of an exophytic subepithelial lesion (SEL) in the stomach is challenging. Exophytic lesions are more amenable to surgical resection and are a relative contraindication for endoscopic resection.

The use of magnets in endoscopy has been described for over 75 years. The first experimental study of magnetic compression gastrojejunostomy was described in 1995, with the magnets introduced by means of the endoscopic technique perorally or through a gastrostomy.

A 64-year-old man with a history of metastatic squamous cell carcinoma of the larynx underwent laryngopharyngectomy with good response to adjuvant combination of immunotherapy and chemotherapy.

The standard treatment for invasive squamous cell anal cancer is chemoradiation treatment. However, treatment options for high-grade dysplasia (squamous cell cancer in situ) are either surgical excision or topical treatment modalities.