Review of Simultaneous Double Stenting Using Endoscopic Ultrasound-Guided Biliary Drainage Techniques in Combined Gastric Outlet and Biliary Obstructions.

Concomitant malignant gastric outlet obstruction and biliary obstruction may occur in patients with advanced cancers affecting these anatomical regions. This scenario presents a unique challenge to the endoscopist in selecting an optimal management approach. We sought to determine the efficacy and safety of endoscopic techniques for treating simultaneous gastric outlet and biliary obstruction (GOBO) with endoscopic ultrasound (EUS) guidance for biliary drainage.

De-novo Gastrointestinal Anastomosis with Lumen Apposing Metal Stent.

Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate.

Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture.

Management of benign gastrointestinal (GI) strictures refractory to primary (balloon and savary dilation) and secondary (steroid injection, fully covered self-expanding metal stent, incision therapy) treatment modalities remains a challenge. Lumen-apposing metal stents (LAMSs), originally designed for the management of pancreatic fluid collections, are an attractive option for GI stricture because of their anti-migratory property, attributable to their saddle-shaped design. In this article, we reviewed 70 patients from 12 original studies who received LAMS for refractory (68/70) or treatment-naïve (2/70) benign GI stricture.

Contrast Enhanced Harmonic Endoscopic Ultrasound: A Novel Approach for Diagnosis and Management of Gastrointestinal Stromal Tumors.

The histologic analysis of gastrointestinal stromal tumors (GISTs) is a common method to detect the mitotic activity and to subsequently determine the risk of GISTs for malignancy. The potential false negative error due to inadequate yield of specimens and actual determination of malignancy risk requires analysis of the whole tumor. We aimed to assess the role of contrast enhanced endoscopic ultrasound (CE-EUS) in the management of GISTs.

Endoscopic Ultrasound-Guided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: A Systematic Review.

Surgery remains the standard treatment for acute cholecystitis except in high-risk candidates where percutaneous transhepatic gallbladder drainage (PT-GBD), endoscopic transpapillary cystic duct stenting (ET-CDS), and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) are potential choices. PT-GBD is contraindicated in patients with coagulopathy or ascites and is not preferred by patients owing to aesthetic reasons. ET-CDS is successful only if the cystic duct can be visualized and cannulated.

Endoscopic Ultrasound Guided Choledocho-Enterostomy by Using Lumen Apposing Metal Stent in Patients with Failed Endoscopic Retrograde Cholangiopancreatography: A Literature Review.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been the cornerstone in the management of malignant jaundice to provide symptomatic relief and/or to allow chemotherapy. Difficult biliary cannulation or the presence of concomitant duodenal obstruction may lead to its failure.

Method: An extensive English literature search was done via PubMed and Google Scholar to identify 13 peer-reviewed original articles.

Closing the Gaps: Endoscopic Suturing for Large Submucosal and Full-Thickness Defects.

This article is a systematic review of relevant literature on endoscopic suturing as a primary closure technique for large submucosal and full-thickness defects after endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). A comprehensive literature search was conducted through 2016 by using PubMed, to find peer-reviewed original articles. The specific factors considered were the procedural indications and details, success rates, clinical outcomes including complications, and study limitations.

Efficacy and Safety of Flexible Endoscopic Management of Zenker's Diverticulum.

Zenker's diverticulum (ZD), a pulsion diverticulum of hypopharynx is a rare but treatable cause of morbidity in geriatric population. Traditionally a surgical disease but due to its associated high morbidity, flexible endoscopy has become a lucrative option. We reviewed 997 patients from 23 original studies who underwent flexible endoscopic diverticulotomy (FED) of ZD.

Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria.

Background: American Society of Gastrointestinal Endoscopy (ASGE) criteria is widely used to predict probability of choledocholithiasis among patients with symptomatic gallstone disease but does not take sex into consideration.

Methods: The cohort study included patients who underwent either endoscopic retrograde cholangiopancreatography or intraoperative cholangiography for suspected choledocholithiasis at our medical center. Clinical, laboratory and radiological data were collected for each patient and used to stratify them based on the ASGE risk criteria for choledocholithiasis.

Volumetric Laser Endomicroscopy for Barrett's Esophagus - Looking at the Fine Print.

Barrett's esophagus (BE) is a premalignant condition. The incidence of adenocarcinoma in BE has been reported to be between 0.1-3%.

Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures.

Benign anastomotic strictures can occur in up to 22% of patients who undergo colonic or rectal resection. Traditionally, surgery was the preferred method of treatment, but, over time, endoscopic techniques, such as balloon dilation, have become the preferred modality. However, a high stricture recurrence rate of up to 18-20% and the increased risk of perforation due to uncontrolled stretching are its major drawbacks.

analysis of mucosal lipids reveals histological disease activity in ulcerative colitis using endoscope-coupled Raman spectroscopy.

The goal of this study is to evaluate endoscopic Raman spectroscopy as a noninvasive technique to determine histological inflammatory status of colitis. Colon mucosal composition was investigated from patients with ulcerative colitis (UC) and from age- and body mass index (BMI) matched controls using endoscope-coupled Raman spectroscopy. The results were co-registered with histological assessment of inflammatory status at the same locations.

Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity.

Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity.

Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria.

The management of incidentally discovered small upper gastrointestinal (GI) tract submucosal tumors (SMT) remains debatable. In this review, we summarize the evolving experience with submucosal tunneling endoscopic resection (STER) of upper GI SMTs originating from the muscularis propria. From 16 original studies, we reviewed a total of 703 patients with 736 lesions.

Biodegradable Stents: An Evolution in Management of Benign Intestinal Strictures.

Benign intestine strictures secondary to postoperative narrowing or inflammatory bowel disease can be managed surgically or conservatively. Some patients may not be suitable surgical candidates and some patients may choose not to have repeat surgery. Biodegradable (BD) stents offer a prolonged dilatory effect before gradual degradation and obviates the need of a second procedure for stent removal.

Endoscopic full thickness resection for gastric tumors originating from muscularis propria.

Aim: To do systematic review of current literature for endoscopic full thickness resection (EFTR) technique for gastric tumors originating from muscularis propria.

Methods: An extensive English literature search was done till December 2015; using PubMed and Google scholar to identify the peer reviewed original and review articles using keywords-EFTR, gastric tumor, muscularis propria. Human only studies were included.

Endoscopic ultrasound-assisted gastrointestinal hemostasis: an evolving technique.

Gastrointestinal bleeding can range from grossly visible blood in stool or vomitus to microscopic bleed. However, any kind of bleeding can lead to potential life-threatening consequences. A small proportion of patients with gastrointestinal bleeding remain refractory to initial endoscopic hemostasis.

Impact of glycemic control on colonoscopy outcomes: bowel preparation and polyp detection.

Background: The negative effect of diabetes mellitus (DM) on the colonoscopy preparation has been previously established. Metabolic syndrome has been shown to increase risk for malignancy and possibly for premalignant lesions. This study aimed to investigate the impact of DM control on colonoscopy outcomes including bowel preparation and adenoma detection rate (ADR).

New Developments in Mechanical Enhancement of Colonoscopy: Cuffs, Caps and Rings.

Background: Colorectal cancer (CRC) is a common cause of cancer-related deaths. Early detection of precursor lesions in the adenoma-carcinoma sequence via colonoscopy can decrease mortality from CRC.

Summary: In this review article, we have summarized retrospective studies, prospective single center, multicenter studies and randomized controlled trials describing the efficacy of endocuff colonoscopy (EC), cap-assisted colonoscopy (CAC) and endorings colonoscopy (ERC).