Fully-covered metal stents with endoscopic suturing vs. partially-covered metal stents for benign upper gastrointestinal diseases: a comparative study.

Background And Study Aims: Self-expandable metallic stents (SEMS) have been increasingly used in benign conditions (e. g. strictures, fistulas, leaks, and perforations).

Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study.

Background And Study Aims: Fully covered self-expandable metal stents (FCSEMSs) have increasingly been used in benign upper gastrointestinal (UGI) conditions; however, stent migration remains a major limitation. Endoscopic suture fixation (ESF) may prevent stent migration. The aims of this study were to compare the frequency of stent migration in patients who received endoscopic suturing for stent fixation (ESF group) compared with those who did not (NSF group) and to assess the impact of ESF on clinical outcome.

A Large Multicenter Experience With Endoscopic Suturing for Management of Gastrointestinal Defects and Stent Anchorage in 122 Patients: A Retrospective Review.

Goals: To describe a multicenter experience using an endoscopic suturing device for management of gastrointestinal (GI) defects and stent anchorage.

Background: Endoscopic closure of GI defects including perforations, fistulas, and anastomotic leaks as well as stent anchorage has improved with technological advances. An endoscopic suturing device (OverStitch; Apollo Endosurgery Inc.

Foregut and colonic perforations: practical measures to prevent and assess them.

Acute endoscopic perforations of the foregut and colon are rare but can have devastating consequences. There are several principles and practices that can lower the risk of perforation and guide the endoscopist in early assessment when they do occur. Mastery of these principles will lead to overall improved patient outcomes.

Nurse observation during colonoscopy increases polyp detection: a randomized prospective study.

Objectives: To determine whether a second observer during colonoscopy increases adenoma detection.

Methods: Consecutive patients undergoing screening colonoscopy were prospectively randomized to routine colonoscopy or physician and nurse observation during withdrawal.

Results: Of 502 patients, 249 were randomized to routine colonoscopy, and 253 to physician plus nurse observation during withdrawal.

Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts.

Background: Characterization of pancreatic cysts by using EUS-FNA includes chemical and cytologic analysis.

Objective: To evaluate whether material obtained from FNA of the cyst wall increases diagnostic yield.

Design: Prospective series.

Cyst wall puncture and aspiration during EUS-guided fine needle aspiration may increase the diagnostic yield of mucinous cysts of the pancreas.

Background: Pancreatic cysts are common, however, their diagnosis and classification remains a challenge despite advances in cross-sectional imaging and endoscopic ultrasound with fine needle aspiration (EUS-FNA).

Objective: To determine the incremental yield of cytologic examination of material obtained from targeted fine needle aspiration ("puncture") of the cyst wall after aspiration of fluid for CEA.

Design: Retrospective consecutive series.

Narrow band imaging to detect residual or recurrent neoplastic tissue during surveillance endoscopy.

Background: There is little data on the prevalence of residual neoplastic tissue or the rate of endoscopically detected recurrence in patients with prior surgical or endoscopic resection of advanced neoplasia.

Aims: To compare standard white light with NBI for both the detection, as well as the differentiation, of residual or recurrent neoplastic tissue during real-time endoscopy.

Methods: A prospective study of 46 consecutive patients undergoing surveillance colonoscopy or upper endoscopy was conducted.

Fellow involvement may increase adenoma detection rates during colonoscopy.

Background: Adenoma detection rate (ADR) is increasingly used as a quality indicator for screening/surveillance colonoscopy. Recent investigations to identify factors that affect ADR have focused on the technical aspects of the procedure or the equipment.

Objective: To assess whether gastroenterology (GI) fellow participation during colonoscopy affects ADR.

Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience.

Background: There is no widely adopted, easily applied method for distinguishing between adenomatous and nonadenomatous polyps during real-time colonoscopy.

Objective: To compare white light (WL) with narrow-band imaging (NBI) for the differentiation of colorectal polyps in vivo and to assess for a learning curve.

Design: A prospective polyp series.

Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center.

Background: A significant number of self-expandable metal stents (SEMSs) placed to palliate malignant biliary obstruction will occlude. Few data exist as to what constitutes optimal management.

Objective: Our purpose was to review the management and outcomes of patients with biliary SEMS occlusion.

Type I autoimmune hepatitis presenting with acute liver failure in the setting of wild mushroom ingestion.

Type I autoimmune hepatitis usually has an indolent presentation and course, and is classically thought of as a disease of young women, but can in fact occur across all age ranges. Although its etiology remains unclear, it is hypothesized that an environmental antigen may trigger the disease in a genetically susceptible individual. Here, we report the unusual case of a woman in her seventh decade who presented with acute liver failure as her initial manifestation of autoimmune hepatitis, and who had been a long-time ingestor of hand-picked, wild mushrooms.

Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome).

Bouveret's syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula. Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb.

Multiphoton imaging can be used for microscopic examination of intact human gastrointestinal mucosa ex vivo.

Background & Aims: The ability to observe cellular and subcellular detail during routine endoscopy is a major goal in the development of new endoscopic imaging techniques. Multiphoton microscopy, which relies on nonlinear infrared optical processes, has the potential to identify cellular details by excitation of endogenous fluorescent molecules. We examined the feasibility of using multiphoton microscopy to characterize mucosal histology in the human gastrointestinal tract.