Submucosal injection fluid and tattoo agents.

Background And Aims: EMR and endoscopic submucosal dissection (ESD) are minimally invasive endoscopic techniques, developed for the removal of benign and early malignant lesions throughout the GI tract. Submucosal injection of a marking agent can help to identify lesions during surgery. Endoscopic resection frequently involves "lifting" of the lesions by injection of a substance within the submucosal space to create a cushion for safe resection.

The effect of per-oral endoscopic myotomy by achalasia subtype as measured by impedance planimetry.

Background: Achalasia is an esophageal motility disorder with three subtypes based on manometry that can treated with per-oral endoscopic myotomy (POEM). With the advent of impedance planimetry (EndoFLIP®), we hypothesized the three achalasia subtypes would have different pre-POEM EndoFLIP® diameter and distensibility index (DI) measurements but would be similar after POEM.

Methods: A single-institution, retrospective review of consecutive POEM cases by a single surgeon-endoscopist team from 04/07/2017 to 08/28/2023.

Impedance planimetry during per-oral endoscopic myotomy is associated with decreased inadvertent capnoperitoneum.

Background: Per-oral endoscopic myotomy (POEM) has become an accepted minimally invasive alternative to Heller myotomy for the treatment of achalasia and other disorders of esophageal dysmotility. One associated adverse event is the inadvertent creation of capnoperitoneum. A proposed mechanism is that extension of the submucosal tunnel below the esophageal hiatus and onto the gastric wall leads to transmural perforation.

Per-oral endoscopic myotomy for the treatment of non-achalasia esophageal dysmotility disorders: experience from a single high-volume center.

Background: Achalasia is a rare disorder of esophageal motility that induces progressive intolerance to oral intake. Other esophageal dysmotility disorders include esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), hypercontractile esophagus (HE), and other minor disorders of peristalsis (MDP) and can present similarly to achalasia despite different pathophysiologies. Prior studies have demonstrated the safety and efficacy of POEM in the treatment of achalasia, but little is reported regarding POEM's role in treating non-achalasia esophageal dysmotility disorders (NAEDD).

Mucinous Signet-Cell Adenocarcinoma of the Ileum: A Diagnostic Challenge-Case Report and Review of the Literature.

Malignancies of the small intestine are rare. Signet-ring cell carcinoma (SRCC) is one of the rarest forms of adenocarcinoma that can arise in the small intestines. We present a case of a patient who originally presented with abdominal pain and radiographic findings suggestive of ileal congestion.

Rehospitalization, Treatment, and Resource Use After Inpatient Admission for Achalasia in the USA.

Introduction: Readmission for achalasia treatment is associated with significant morbidity and cost. Factors predictive of readmission would be useful in identifying patients at risk.

Methods: We performed a retrospective study using the Nationwide Readmission Database for the year 2016 and 2017.

Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta-analysis.

Background: Gastric antral vascular ectasia is an infrequent cause of gastrointestinal-related blood loss manifesting as iron-deficiency anemia or overt gastrointestinal bleeding, and is associated with increased healthcare burdens. Endoscopic therapy of gastric antral vascular ectasia most commonly involves endoscopic thermal therapy. Endoscopic band ligation has been studied as an alternative therapy with promising results in gastric antral vascular ectasia.

Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy.

Background: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM).

Methods: A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews.

Hepatic Sarcoidosis Complicated with Pancreatic Adenocarcinoma.

Sarcoidosis is a systemic noncaseous granulomatous disease. The liver is a common location but usually asymptomatic. Current literature suggests an association between sarcoidosis and cancers.

Two Cases of Gastrointestinal Delusional Parasitosis Presenting as Folie á Deux.

Delusional parasitosis is a psychiatric illness in which patients believe that they are infested by parasites without any evidence to support this belief. Cases typically involve cutaneous manifestations. We present 2 cases of gastrointestinal delusional parasitosis, with one unfortunate fatal outcome.

Gastrointestinal Endoscopy Editorial Board top 10 topics: advances in GI endoscopy in 2018.

The American Society for Gastrointestinal Endoscopy's Gastrointestinal Endoscopy Editorial Board reviewed original endoscopy-related articles published during 2018 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of adenoma detection, bariatric endoscopy, EMR/submucosal dissection/full-thickness resection, artificial intelligence, expandable metal stents for palliation of biliary obstruction, pancreatic therapy with lumen-apposing metal stents, endoscope reprocessing, Barrett's esophagus, interventional EUS, and GI bleeding.

Myotomy length informed by high-resolution esophageal manometry (HREM) results in improved per-oral endoscopic myotomy (POEM) outcomes for type III achalasia.

Introduction: High-resolution esophageal manometry (HREM) is essential in characterizing achalasia subtype and the extent of affected segment to plan the myotomy starting point during per-oral endoscopic myotomy (POEM). However, evidence is lacking that efficacy is improved by tailoring myotomy to the length of the spastic segment on HREM. We sought to investigate whether utilizing HREM to dictate myotomy length in POEM impacts postoperative outcomes.

Treatment of Achalasia with Per-Oral Endoscopic Myotomy: Analysis of 50 Consecutive Patients.

Background: Peroral endoscopic myotomy (POEM) has become an acceptable incisionless treatment for achalasia based on encouraging outcomes in multiple series worldwide. This report reflects our early experience.

Methods: Data were collected prospectively on all patients undergoing POEM between June 2011 and April 2016 under IRB approval.

The NOVEL trial: natural orifice versus laparoscopic cholecystectomy-a prospective, randomized evaluation.

Introduction: The evolution of Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents a case study in surgical procedural evolution. Beginning in 2004 with preclinical feasibility studies, and followed by the creation of the NOSCAR collaboration between The Society of American Gastrointestinal and Endoscopic Surgeons and the American Society for Gastrointestinal Endoscopy, procedural development followed a stepwise incremental pathway. The work of this consortium has included white paper analyses, obtaining outside independent funding for basic science and procedural development, and, ultimately, the initiation of a prospective randomized clinical trial comparing NOTES cholecystectomy as an alternative procedure to laparoscopic cholecystectomy.

An international multicenter study evaluating the clinical efficacy and safety of per-oral endoscopic myotomy in octogenarians.

Background And Aims: Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly because it is minimally invasive. However, data in patients aged ≥80 years are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians.

Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia After Failed Heller Myotomy.

Background & Aims: In patients with persistent symptoms after Heller myotomy (HM), treatment options include repeat HM, pneumatic dilation, or peroral endoscopic myotomy (POEM). We evaluated the efficacy and safety of POEM in patients with achalasia with prior HM vs without prior HM.

Methods: We conducted a retrospective cohort study of 180 patients with achalasia who underwent POEM at 13 tertiary centers worldwide, from December 2009 through September 2015.

Management of post-ERCP complications.

Endoscopic retrograde cholangiopancreatography (ERCP) has the highest risk of complication of any endoscopic procedure routinely performed by gastroenterologists or surgeons. Adverse events are inevitable when performing ERCP, and one must learn to manage these appropriately when they occur. One avenue for a successful outcome after a complication of ERCP is to follow the "5R model" of management: recognize, react, reach out, repent, and revisit.

Open access colonoscopy: Critical appraisal of indications, quality metrics and outcomes.

Introduction: In an era of cost containment and measurement of value, screening for colon cancer represents a clear target for better accountability. Bundling payment is a real possibility and will likely have to rely on open-access colonoscopy (OAC). OAC is a method to allow patients to undergo endoscopy without prior evaluation by a gastroenterologist.

Adenomas involving the extrahepatic biliary tree are rare but have an aggressive clinical course.

Biliary adenomas that are usually found in surgically removed gallbladders are rare, but can also occur in the extrahepatic biliary tree. We present a case series of extrahepatic bile duct adenomas at our institution, along with a review of the literature. All three patients with extrahepatic biliary adenomas (two in the common bile ducts, one in the hepatic duct) were female with a mean age of 74 years.

The impact of lifestyle on Barrett's Esophagus: A precursor to esophageal adenocarcinoma.

Background: Barrett's Esophagus (BE), particularly long-segment Barrett's Esophagus, and the age of onset of Barrett's Esophagus are risk factors for esophageal adenocarcinoma. However, it is unknown if lifestyle factors such as alcohol abuse, tobacco use, weight gains that increase the risk of developing BE and esophageal adenocarcinoma affect its length or age at diagnosis.

Methods: In a retrospective, cross-sectional analysis, we analyzed 158 newly diagnosed adult BE patients at a 600-bed tertiary care center in the United States from 1999 to 2008.