Endoscopic Mucosal Resection: Best Practices for Gastrointestinal Endoscopists.

Endoscopic mucosal resection (EMR) is an endoscopic technique used to remove sessile or flat lesions from the gastrointestinal tract. This article reviews EMR and focuses on large colorectal polyps, which constitute the most common indication for EMR. Various methods of polyp evaluation can help gastroenterologists determine whether EMR is feasible and whether referral to an advanced endoscopist may be necessary.

The Role of Endoscopic Ultrasound (EUS) in the Management of Gastric Varices.

Purpose Of Review: Gastric varices (GV) are an important complication of portal hypertension, and the current recommendation for management is beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt (TIPS) for active bleeding or secondary prophylaxis. Direct endoscopic injection of cyanoacrylate (CYA) glue has been investigated but has drawbacks including limited endoscopic characterization of GV and possible distal glue embolism. To this end, endoscopic ultrasound (EUS) has been pursued to help in characterization of GV, visualization of treatment in real time, and confirmation of obliteration with Doppler.

Gene Expression Changes Accompanying the Duodenal Adenoma-Carcinoma Sequence in Familial Adenomatous Polyposis.

Objectives: Duodenal cancer in familial adenomatous polyposis (FAP) arises from adenomas. Differentially expressed genes (DEGs) in the duodenal adenoma-carcinoma pathway have been identified in murine FAP models, but similar data in patients with FAP are limited. Identifying such changes may have significance in understanding duodenal polyposis therapies and identifying cancer biomarkers.

Pre-cancerous colon polyps in the young - incidental adenoma detection in average-risk persons forty and younger.

Of 166 consecutive diagnostic colonoscopies performed on persons aged forty and under (excluding those at an increased risk of colon neoplasms) by a single gastroenterologist in community practice with an Adenoma Detection Rate (ADR) approaching 70% in average-risk screening colons in persons over fifty, 34 had incidentally detected colon adenomas and 38 had serrated polyps. We suggest routine tabulation of incidentally detected polyps in young people to better understand colon neoplasm biology and plan prevention strategies.

Chronic pancreatitis changes in high-risk individuals for pancreatic ductal adenocarcinoma.

Background And Aims: Pancreatic intraepithelial neoplasia is associated with chronic pancreatitis (CP) changes on EUS. The objective of this study was to determine whether CP changes were more common in high-risk individuals (HRIs) than in control subjects and whether these changes differed among higher-risk subsets of HRIs.

Methods: HRIs and control subjects were identified from an endoscopy database.

Spigelman stage IV duodenal polyposis does not precede most duodenal cancer cases in patients with familial adenomatous polyposis.

Background And Aims: The greatest known risk factor for duodenal cancer in familial adenomatous polyposis (FAP) is Spigelman stage (SS) IV duodenal polyposis. Endoscopic surveillance is recommended in FAP patients with SS 0 to IV, and prophylactic duodenectomy should be considered in SS IV. Cancer occurs in patients without SS IV polyposis.

Multiple myeloma presenting with unilateral abducens and trigeminal nerve palsies.

Petrous apex masses can manifest with neurologic symptoms due to their involvement of various structures, including cranial nerves (CN) V and VI. The differential diagnosis of petrous masses is broad and includes a variety of both non-neoplastic and neoplastic lesions. We report a rare case of multiple myeloma confined to the right petrous apex, presenting with ipsilateral abducens and trigeminal nerve palsies.