Endoscopic hemostatic spray for uncontrolled bleeding after complicated endoscopic mucosal resection or endoscopic submucosal dissection: a report of 2 cases.

Background And Aims: There is a significant bleeding risk after gastric endoscopic submucosal dissection (ESD) and EMR cases. This case series describes the use of an endoscopic hemostasis spray, which is not typically used to treat this type of bleeding, after multiple attempts with other modalities failed.

Methods: We present 2 patient cases of ESD and EMR used to treat a gastric adenoma (case 1) and 2 gastric hyperplastic masses (case 2) with refractory bleeding after use of multiple other treatment modalities.

The Durability of EUS-Guided Chemoablation of Mucinous Pancreatic Cysts: A Long-Term Follow-Up of the CHARM trial.

Pancreatic cancer has known precursor lesions with potential to develop into malignancy over time. At least 20% of pancreatic cancer evolves from mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, which are often discovered incidentally. Current guidelines for the management of mucinous cystic neoplasms and intraductal papillary mucinous neoplasms include long-term surveillance, which is expensive and nontherapeutic, or surgical resection, which is associated with major risk and may not be an option for patients with significant concomitant illness.

Pancreatitis kills cysts: A phenomenon that illustrates the potential role of immune activation in premalignant cyst ablation.

 Pancreatic cystic lesions are being increasingly recognized on cross-sectional imaging and mucinous premalignant cysts represent one of the most prevalent types. Endoscopic ultrasound (EUS)-guided chemoablation offers a safe and minimally invasive ablation approach yet with limited efficacy. Patients who develop acute pancreatitis as a complication of chemoablation with alcohol however experience ablation rates up to 100 %.

Endoscopic Management of Large Peripancreatic Fluid Collections in Two Pediatric Patients by Endoscopic Ultrasound-guided Transmural Drainage.

The incidence of acute pancreatitis (AP) has increased in the pediatric population over the past few decades and it stands to follow that the complications of severe AP, including symptomatic pancreatic fluid collections (PFCs) will increase as well. In adults, the therapeutic options for this situation have undergone a dramatic evolution from mainly surgical approaches to less invasive endoscopic approaches, mainly endoscopic ultrasound-guided transmural drainage (EUS-TD) followed be direct endoscopic necrosectomy if needed. This has proven safe and effective in adults; however, this approach has not been well studied or reported in pediatric populations.

Percutaneous debridement and washout of walled-off abdominal abscess and necrosis by the use of flexible endoscopy: an attractive clinical option when transluminal approaches are unsafe or not possible.

Background And Aims: Walled-off pancreatic necrosis is a well-known serious adverse event of severe acute pancreatitis. EUS-guided transluminal access followed by direct endoscopic necrosectomy is increasingly used to remove necrosis, with good efficacy and a superior safety profile when compared with surgery. However, a percentage of patients is too critically ill to undergo this procedure or lack an appropriate transluminal window for access.

Successful treatment of large cavity esophageal disruptions with transluminal washout and endoscopic vacuum therapy: a report of two cases.

Acute, high-grade esophageal perforation and postoperative leak after esophagogastrostomy are associated with high morbidity and mortality due to the development of mediastinitis and thoracic contamination. Endoscopic vacuum therapy has proven to be a feasible, safe therapy for management of esophageal wall defects, but with limited success. We describe a retrospective single-center analysis of two patients who underwent endoscopic vacuum therapy for significant esophageal disruptions with a median cross-sectional diameter of 10.

When high viscosity of pancreatic cysts precludes effective EUS-FNA: a benchtop comparison of negative pressure devices.

 Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs) is an important diagnostic tool; however, it is often unsuccessful due to high viscosity of cystic fluid. In an effort to improve FNA, we objectively compared eight vacuum device configurations to determine the most effective method for aspirating viscous fluid collections. We also tested a high-frequency oscillation (HFO) technique that could be employed in FNA.

Juxtapapillary duodenal diverticulitis in an elderly female.

We describe the case of an 82-year-old Caucasian woman who presented to our institution as a transfer from an outside hospital with nausea, vomiting and abdominal pain with CT imaging concerning for a duodenal mass or abscess in the juxtapapillary region of the second part of the duodenum. Upper endoscopy showed a non-bleeding duodenal diverticulum with purulent discharge consistent with diverticulitis. She underwent endoscopic disimpaction with irrigation and received a 14 day course of antibiotics, after which she presented for follow-up 1 month after discharge without complications.

Cryptococcal Meningitis in an Apparent Immunocompetent Patient.

Cryptococcal meningitis is an uncommon and severe infection that tends to affect immunocompromised hosts worldwide and in the United States. Annually it is estimated that there are 200 000 cases of cryptococcal meningitis, with the most recent estimate of 3400 cases per year in the United States alone. However, despite the low incidence, 1-year mortality is estimated at 20% to 30% even with long-term consolidation antifungal therapy.

Transluminal washout and debridement of extraluminal contamination as an adjunct to endoscopic defect repair.

Background And Aims: GI tract perforations and anastomotic dehiscence are increasingly effectively being repaired endoscopically; however, well-known and long-held surgical principles must still be honored. One important principle is that significant extraluminal contamination must be washed out, debrided, and drained in conjunction with repair of the defect if the wound is to effectively heal and resolve. Here we describe the use of endoscopic washout and debridement of extraluminal contamination at the time of luminal defect closure in a 7-patient series at our institution, with video demonstration of 2 patients in the series.

Bilateral Compartment Syndrome in Intravenous Drug Abuse.

Compartment syndrome is an orthopedic emergency in which the neurovasculature of the extremity is compromised. Typically, it presents unilaterally and is the consequence of major trauma to the extremity in the form of fracture. However, more uncommon etiologies of compartment syndrome have been reported, which includes reperfusion injury, burns, and congenital or acquired bleeding disorders.

A Case of Adalimumab-associated Pancytopenia and Reversible Lymphadenopathy.

Adalimumab is a recombinant monoclonal antibody to tumor necrosis factor alpha (TNFα) used in the treatment of inflammatory and autoimmune conditions, including ulcerative colitis (UC). Adverse side effects include infection and injection-site cutaneous reactions; however, rare adverse events such as pancytopenia have been recorded. Here we describe a case of pancytopenia and reversible lymphadenopathy related to adalimumab administration in a patient with UC.