Changes in Distensibility Index During an Incremental POEM Myotomy.

Background: A longer myotomy for the treatment of achalasia is associated with worse gastroesophageal reflux disease despite palliating dysphagia. Recently, clinical outcomes have been correlated to the distensibility of the distal esophagus, which is measured intra-operatively using an endoscopic functional luminal image probe (EndoFLIP). We aimed to determine the minimum per oral endoscopic myotomy (POEM) length to allow for adequate distensibility index (DI).

Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding.

Objective: The Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care.

Design: We reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator.

A Matched Comparison of Per Oral Endoscopic Myotomy to Laparoscopic Heller Myotomy in the Treatment of Achalasia.

Background: Per oral endoscopic myotomy (POEM) is increasingly utilized to treat patients with achalasia. Early results have demonstrated significant improvement of symptoms, but there are concerns about postoperative reflux. With only limited comparative data available, we sought to compare POEM to laparoscopic Heller myotomy (LHM) with partial fundoplication.

Impact of prior interventions on outcomes during per oral endoscopic myotomy.

Background: Per oral endoscopic myotomy (POEM) is performed by accessing the submucosal space of the esophagus. This space may be impacted by prior interventions such as submucosal injections, dilations or previous myotomies. These interventions could make POEM more difficult and may deter surgeons during their initial experience.

Double-balloon enteroscopy in Crohn's disease: findings and impact on management in a multicenter retrospective study.

Background: Double-balloon enteroscopy (DBE) is effective in visualizing the small bowel to perform biopsy sampling and interventions. Few studies have evaluated the utility of DBE in patients with known or suspected Crohn's disease (CD).

Objective: To evaluate the use of DBE in the diagnosis and impact on patient management in known and suspected CD and to compare capsule endoscopy (CE) with DBE findings.

International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video).

Background: The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with standard clips. Only case reports and small case series have reported on outcomes of OTSC closure of GI defects.

Objective: To describe a large, multicenter experience with OTSCs for the management of GI defects.

Outcomes in patients who have failed endoscopic therapy for dysplastic Barrett's metaplasia or early esophageal cancer.

Background: Endoscopic therapy (ablation ± mucosal resection) for esophageal high-grade dysplasia (HGD) or intramucosal carcinoma has demonstrated promising results. Little is known about patients who have persistent or progressive disease despite endotherapy. We compared patients who had successful eradication of their disease with those in whom endotherapy failed to try to identify factors predictive of failure and outcomes after salvage therapy.

Impact of endoscopic assessment and treatment on operative and non-operative management of acute oesophageal perforation.

Background: Surgeons have not typically utilized an endoscopic approach for diagnosis and management of acute oesophageal perforation, mainly due to fears of increased mediastinal contamination. This study assessed the evolution of endoscopic approaches and their effect on outcomes over time in acute oesophageal perforation.

Methods: All patients with documented acute oesophageal perforation between 1990 and 2009 were enrolled prospectively in an Institutional Review Board-approved database.

Esophageal reconstitution by simultaneous antegrade/retrograde endoscopy: re-establishing patency of the completely obstructed esophagus.

Complete obstruction of the proximal esophagus is an uncommon complication of radiotherapy. Standard endoscopic dilation is not possible because no lumen exists. We describe a retrospective case series in which rendezvous endoscopy, tissue puncture, dilation, and stenting were used to restore function to a group of patients with complete esophageal obstruction.

Spiral overtube-assisted colonoscopy after incomplete colonoscopy in the redundant colon.

Background: A redundant colon can lead to incomplete colonoscopy. A variety of tools and techniques are available to complete colonoscopy but have limitations.

Objective: To determine the feasibility and safety of using a spiral overtube to complete a difficult colonoscopy.

The effect of periodic monitoring and feedback on screening colonoscopy withdrawal times, polyp detection rates, and patient satisfaction scores.

Background: Previous studies showed a correlation between mean withdrawal times during screening colonoscopy and polyp/neoplasia detection rates.

Objectives: To assess the effect of a monitoring and feedback program on withdrawal times, polyp/neoplasia detection rates, and patient satisfaction.

Design: Comparison of retrospective and prospective data.

Advances in esophageal stenting: the evolution of fully covered stents for malignant and benign disease.

Self-expanding metal stents have become a leading palliative therapy for dysphagia resulting from esophageal, proximal gastric, and mediastinal cancers. Increasingly, fully covered self-expanding plastic stents and now fully covered metal stents have been used to treat a variety of benign esophageal conditions as well as cancer. Several stent designs are available in the United States and many more internationally.

Quality of life after esophagectomy and endoscopic therapy for Barrett's esophagus with dysplasia.

Esophagectomy (EG) and endoscopic therapy (ET) can eradicate Barrett's esophagus with early neoplasia. Their relative effect on quality of life is unknown. The 36-item Short Form Health Survey (SF-36) and Gastrointestinal Quality of Life Index (GIQLI) questionnaires were sent to all patients who underwent either EG or ET at our institution over the last 9 years.

Recent advances in the use of stents for esophageal disease.

The use of self-expanding metal esophageal stents has evolved dramatically over the last 20 years. Stents themselves have morphed from simple open-mesh wire devices to a variety of partially and fully covered metal and plastic protheses designed to resist in-growth and migration. Indications include grown considerably from simply palliating malignant dysphagia to the treatment of benign conditions such as refractory strictures, perforations, and fistulas, bridging tumors through neoadjuvant therapy and even serving as support for mucosal healing after ablative therapies.

Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period.

Background: Tumors arising from the duodenal papilla account for approximately 5% of GI neoplasms, but are increasingly identified.

Objective: To describe the clinical characteristics and outcomes in a large single-center experience with patients referred for ampullary lesions.

Design: A retrospective review of the Virginia Mason Medical Center endoscopy and hospital service database.