Variceal ligation in decompensated cirrhosis before esophageal endoscopic submucosal dissection.

Video 1This video details our case as well as our method for successfully eradicating varices immediately prior to esophageal endoscopic submucosal dissection to minimize risks of variceal hemorrhage.

Accuracy and Inter-observer Agreement Among Endoscopists for Visual Identification of Colorectal Polyps Using Endoscopy Images.

Background: It is essential to accurately distinguish small benign hyperplastic colon polyps (HP) from sessile serrated lesions (SSL) or adenomatous polyps (TA) based on endoscopic appearances. Our objective was to determine the accuracy and inter-observer agreements for the endoscopic diagnosis of small polyps.

Methods: High-quality endoscopic images of 30 small HPs, SSLs, and TAs were used randomly to create two-timed PowerPoint slide sets-one with and another one without information on polyp size and location.

Purely endoscopic appendectomy.

Video 1Submucosal nodule in the cecum. After submucosal injection, a circumferential incision of the mucosa surrounding the lesion is performed with DualKnife (Olympus America, Center Valley, Pa, USA). The fore-balloon of the double-balloon endoluminal interventional platform (DBEIP) is deployed and the edges of the circumferential incision are attached with 2 endoscopic clips to the long suture-loop mounted on the fore-balloon of the DBEIP.

Endoscopy-Induced Pancreatic Pseudocyst Rupture: A Case of Secondary Peritonitis After Upper Endoscopy.

Pancreatic pseudocysts are often drained endoscopically after 4-6 weeks of maturation. Allowing for developed encapsulation ensures that the cyst walls are strong enough to sustain drainage. However, in 3%-5% of these cases, pseudocysts will rupture spontaneously and put patients at risk of peritonitis.

Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population.

Background And Objectives: The safety and utility of endoscopic ultrasound (EUS) for the evaluation and management of gastrointestinal (GI) tract disorders among adults has been established. The literature on safety and efficacy in a pediatric referral population (under 21 years of age) is limited. We hypothesized that EUS is safe and useful in the pediatric population.

Patients presenting for colonoscopy: A great opportunity to screen for sleep apnea.

Aim: To discover the prevalence and the feasibility of screening for obstructive sleep apnea (OSA) in patients presenting for routine colonoscopy.

Methods: Adult patients having a colonoscopy for routine indications at our outpatient endoscopy center were eligible if they did not carry a diagnosis of OSA or had not had a prior sleep study. All patients were administered the Berlin questionnaire prior to the procedure.

Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience.

Background: Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP.

Methods: Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied.

Airway observations during upper endoscopy predicting obstructive sleep apnea.

Background: This pilot study examined airway characteristics during upper endoscopy to determine who is at high risk for obstructive sleep apnea.

Methods: Patients undergoing routine upper endoscopy were divided into 2 groups according to the Berlin Questionnaire (high and low risk for sleep disordered breathing). Patients underwent routine upper endoscopy using propofol sedation.

Sutureless and Glue-free Versus Sutures for Limbal Conjunctival Autografting in Primary Pterygium Surgery: A Prospective Comparative Study.

Introduction: Sutureless and glue-free conjunctival autograft as a treatment modality for primary pterygium is recently gaining popularity but conventional technique of suturing conjunctival autograft is still practised widely.

Aim: To compare the outcome of sutureless and glue-free technique with sutures for limbal conjunctival autografting in management of primary pterygium.

Materials And Methods: A prospective interventional study was carried out in 50 consecutive eyes with primary nasal pterygium requiring surgical excision.

Serum metabolomic profiling in acute alcoholic hepatitis identifies multiple dysregulated pathways.

Background And Objectives: While animal studies have implicated derangements of global energy homeostasis in the pathogenesis of acute alcoholic hepatitis (AAH), the relevance of these findings to the development of human AAH remains unclear. Using global, unbiased serum metabolomics analysis, we sought to characterize alterations in metabolic pathways associated with severe AAH and identify potential biomarkers for disease prognosis.

Methods: This prospective, case-control study design included 25 patients with severe AAH and 25 ambulatory patients with alcoholic cirrhosis.

Stratification of risk of death in severe acute alcoholic hepatitis using a panel of adipokines and cytokines.

Background: Dysregulated adipose tissue metabolism has been implicated in the pathogenesis of alcoholic liver disease in murine models. We aimed to characterize serum markers of adipose tissue metabolism and inflammation in patients with severe acute alcoholic hepatitis (AAH) and determine their utility to predict survival in severe AAH.

Methods: A prospective, case-control study design was used.

Mucosal IgG4 cell infiltration in ulcerative colitis is linked to disease activity and primary sclerosing cholangitis.

Background: The distribution of IgG4 plasma cells in colonic mucosa, its significance, and relation to disease activity in patients with inflammatory bowel disease (IBD) is unclear. We systematically evaluated IgG4 cell distribution in colonic mucosal biopsies of patients with IBD and correlated histological findings with disease pattern and mucosal inflammation.

Methods: We reviewed clinical records and pathology specimens of 54 randomly selected patients with IBD (13 Crohn's colitis: 7 active, 6 inactive; 18 ulcerative colitis [UC]: 10 active, 8 inactive; 23 UC with primary sclerosing cholangitis: 11 active colitis, 12 inactive colitis), and 11 controls (3 nonspecific diarrhea, 8 collagenous/lymphocytic colitis) who had colonoscopy and biopsies performed at our institution from April 2003 to July 2010.

Enteral feeding patients with gastric outlet obstruction.

Patients with upper gastrointestinal obstructions were previously managed with gastric decompression and parenteral feeding. The authors present their experience in 50 patients with obstructions chiefly due to complicated severe acute (n = 31) or chronic cystic pancreatitis (n = 11) using a double-lumen nasogastric decompression and jejunal feeding tube system (NGJ) held in place with a nasal bridle that passes through the obstructed gastroduodenal segments, allowing distal jejunal feeding, and at the same time decompresses the stomach to prevent vomiting and aspiration. The tip of the jejunal tube was placed approximately 40 cm down the jejunum to maintain pancreatic rest.

Early jejunal feeding initiation and clinical outcomes in patients with severe acute pancreatitis.

Background: Compared with parenteral nutrition, enteral nutrition reduces infectious complications and mortality in patients with severe acute pancreatitis (SAP). This study used clinical outcomes to investigate the association between time to initiation of distal jejunal feeding (DJF) and time to achievement of goal enteral feeding with clinical outcomes.

Methods: A retrospective chart review was performed on all patients with SAP admitted to the medical intensive care unit (ICU) during a 1-year period.

Evaluation and management of autoimmune pancreatitis: experience at a large US center.

Objectives: Autoimmune pancreatitis (AIP) is increasingly recognized as a form of chronic pancreatitis. Systematic evaluation and management of AIP in the United States is reported only from one center. Our aim was to review the evaluation and management of AIP at a large tertiary center.