EUS-Directed transDuodenal ERCP in Concomitant Gastric Outlet and Biliary Obstruction.

Background And Aims: Patients with concomitant gastric outlet obstruction (GOO) and biliary obstruction often have limited management options, particularly in the setting of severe debility. We detail the use of EUS guided gastro-duodenal placement of lumen apposing metal stent (LAMS) as a conduit for transduodenal ERCP: EUS-Directed transDuodenal ERCP (EDDE).

Methods: Nine patients that developed GOO with indwelling biliary metal stents or with anticipated biliary stent placement were retrospectively included.

Non-variceal Upper Gastrointestinal Bleeding and Its Endoscopic Management.

Upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality. Clinical symptoms that patients may present with include: hematemesis, coffee-ground emesis, melena, and hematochezia. Clinical signs can range from tachycardia to shock.

Endoscopic ultrasound-guided gastrojejunostomy for benign gastric outlet obstruction (GOO): a retrospective analysis of patients and outcomes.

Background And Study Aims: Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) has been well utilized in treating malignant gastric outlet obstructions (GOO) given its efficacy and lower risk profile compared to surgery. However, its efficacy and potential for use in patients with benign GOO who are poor surgical candidates is not well documented. The aim of this study was to examine the role of EUS-GJ in treatment of benign GOO in select patients.

Massive infected pancreatic necrosis in an 8-year-old: Endoscopic management.

Pancreatitis is a condition much more commonly found in adults, but when diagnosed in the pediatric population, is often due to medications, congenital pathology, and critical illness. This patient had previously undergone treatment with 6-mercaptopurine and presented with pancreatitis that eventually worsened to a walled-off necrotic collection with paracolic extensions reaching the pelvis. Given clinical worsening with development of shock, procedural options for source control were weighed with gastroenterology, pediatric surgery, and interventional radiology, before pancreatic necrosectomy was determined to be the treatment of choice, given the adjacency of the collection to the stomach.

Uretero-Jejunal Fistula: A Rare Cause of Acute Pyelonephritis.

Penetrating peptic ulcers often lead to severe complications. The development of uretero-enteric fistulas is rare and can be challenging to diagnose and treat. Here, we present the case of a 41-year-old patient who previously underwent gastrojejunostomy for superior mesenteric artery syndrome and developed a peptic jejunal ulcer, leading to a uretero-jejunal fistula and finally causing acute pyelonephritis.

Gastric Outlet Obstruction Secondary to Metastatic Breast Carcinoma 25 Years After Initial Diagnosis: A Mimic of Primary Gastric Carcinoma.

Although breast cancer is the most common form of cancer in women, metastasis to the stomach is incredibly rare. Gastric metastasis of breast cancer has been described in the literature, with an estimated median of 6 years from the initial diagnosis of primary breast cancer to metastasis and multiple instances greater than 10 years. In this case, a patient presented with gastric outlet obstruction in the setting of breast cancer metastasis to the pylorus 25 years after the original diagnosis.

Role of through-the-scope catheter-based EUS in inflammatory bowel disease diagnosis and activity assessment.

Background And Aims: Distinguishing Crohn's disease (CD) from ulcerative colitis (UC) may be difficult when the disease is limited to the colon. Transmural healing is an important adjunctive measure of inflammatory bowel disease activity. The aim of this study was to examine the role of EUS in differentiating CD versus UC and evaluating transmural disease activity.

Does completing advanced endoscopy fellowship improve outcomes after endoscopic mucosal resection?

Background: It was reported that about 60% of the physicians in the USA believed that their Gastroenterology fellowship poorly prepared them for large polyp resection. The aim of this study was to compare endoscopic mucosal resection (EMR) efficacy and complication rates between skilled general gastroenterologists who perform high volume of EMR and advanced endoscopists.

Methods: We identified 140 patients with documented large colonic polyps treated by 4 providers using EMR technique at Carilion Clinic, in Roanoke, Virginia, USA between 01/01/2014-12/31/2017, with follow-up through 10-2018.

Outcomes of Gastrointestinal Polyps Resected Using Underwater Endoscopic Mucosal Resection (UEMR) Compared to Conventional Endoscopic Mucosal Resection (CEMR).

Objective Underwater endoscopic mucosal resection (UEMR) is reported to be superior to conventional endoscopic mucosal resection (CMER) for the complete resection of large polyps and may offer increased procedural efficiency. Aims To compare recurrence rates and adverse events between UEMR and CEMR and define risk factors related to recurrence. Also, to assess recurrence rates in piecemeal endoscopic mucosal resection (EMR) based on the number of pieces resected.

EUS is superior to secretin-enhanced cholangio-MRI to establish the etiology of idiopathic acute pancreatitis.

The etiology of idiopathic acute pancreatitis (IAP) should always be defined. Our aim was to compare the diagnostic value of endoscopic ultrasound (EUS) versus secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in patients with IAP. Patients admitted to a single tertiary care University hospital with IAP were invited to participate in the study.

Endoscopic ultrasound-guided creation of an enterocolostomy to relieve malignant bowel obstruction.

 Malignant bowel obstruction can cause significantly distressing symptoms in patients with end stage cancers, often requiring invasive surgical intervention. With such procedures, risks often outweigh the benefit. We report a novel application of the AXIOS stent and electrocautery-enhanced delivery system to create an enterocolostomy to bypass a small bowel obstruction in the setting of recurrent malignant bowel obstruction.

Outcomes of an international multicenter registry on EUS-guided gallbladder drainage in patients at high risk for cholecystectomy.

 The aim of the current study was to review the outcomes of a large-scale international registry on endoscopic ultrasound-guided gallbladder drainage (EGBD) that encompasses different stent systems in patients who are at high-risk for cholecystectomy.  This was a retrospective international multicenter registry on EGBD created by 13 institutions around the world. Consecutive patients who received EGBD for several indications were included.

Changes in tumor vascularity depicted by contrast-enhanced EUS as a predictor of prognosis and treatment efficacy in patients with unresectable pancreatic cancer (PEACE): A study protocol.

Patients with unresectable pancreatic cancer have a poor prognosis. The analysis of prognostic factors before treatment may be helpful in determining the best therapeutic strategies. The aim of the PEACE study is to assess the vascularity of pancreatic malignant tumors using contrast-enhanced harmonic EUS (CEH-EUS) and to clarify the prognostic value of tumor vascularity in patients with locally advanced and metastatic pancreatic cancer.

Gallbladder Metastases: A Report of Two Cases.

Introduction: Metastasis to the gallbladder is not common and usually manifests an advanced stage of malignancy. Herein, we report a case of triple negative high grade invasive ductal carcinoma of breast with a metastatic lesion to the gallbladder.

Case Presentation: The patient is a 52-year-old female diagnosed with invasive ductal carcinoma treated with mastectomy and chemotherapy.

A tale of two LAMS: a report of benign tissue ingrowth resulting in recurrent gastric outlet obstruction.

 Endoscopic ultrasound (EUS)-guided gastroenterostomy is a novel, off-label, procedure that has been facilitated by availability of a novel lumen apposing metal stent (LAMS) (Axios, Boston Scientific, Marlbourough Massachusetts, United States). The literature suggests its efficacy to be comparable to surgical gastrojejunostomy. In theory, this procedure overcomes the issues associated with woven enteral stents, which are subject to continuous, straightening, axial forces.

Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience.

Aim: To investigate technical feasibility, outcomes and adverse events of the lumen-apposing metal stent (LAMS) for benign gastrointestinal (GI) tract strictures.

Methods: Between July 2015 and January 2017, patients undergoing treatment by LAMS for benign GI strictures at three tertiary referral centers were included in this study. Primary outcomes included technical success, short-term clinical success, long-term clinical success, and adverse events.