Video Journal and Encyclopedia of GI Endoscopy最新文献

In patients with jaundice and unsuccessful biliary drainage with endoscopic retrograde cholangiopancreatography because of a situation after operation (gastrectomy, Roux-y hepaticogastrostomy (HG), Billroth-II operation), endoscopic ultrasound (EUS)-guided biliary drainage has been introduced as an alternative to percutaneous transhepatic cholangial drainage. Here is demonstrated an EUS-guided HG in a patient 1 year after Whipple operation with relapse of pancreatic cancer and with peritonal and hepatic metastases and intrahepatic cholestases. This article is part of an expert video encyclopedia.

Sessile serrated lesions (sessile serrated adenomas or polyps), particularly in the proximal colon, are increasingly recognized as premalignant lesions, which require removal; however, to remove these flat and indistinct lesions in the thin-walled right colon can be technically demanding. In this article, en bloc endoscopic mucosal resection technique is demonstrated for a 12-mm sessile serrated lesion in the proximal colon. This article is part of an expert video encyclopedia.

Examination of the papilla of Vater and biliary system is feasible using radial or longitudinal scanning echoendoscopes, respectively. The complete extrahepatic bile duct may be followed from the papilla to liver hilum. Additionally, the gallbladder and intrahepatic biliary tree of the left liver can be visualized. Altered anatomy and juxtapapillary duodenal diverticulum may impede the evaluation of the papilla and distal common bile duct. Benign stenosis or adenomyomatous hyperplasia of the papilla are conditions occurring predominantly in older patients with a history of gallbladder stones. EUS is the procedure of choice in the evaluation of a dilated common bile duct or in suspected biliary pathology when transabdominal ultrasound fails. This article is part of an expert video encyclopedia.

Sessile serrated colon polyps (SSA/Ps) are precursors to colorectal cancer. In comparison to adenomatous polyps, SSA/P can be challenging to detect during colonoscopy; they are often minimally elevated, pale, and concealed behind mucus, a colonic fold, or intraluminal debris. Because they are typically flat, located in the right side of the colon, the same color as the background mucosa, and have indistinct borders, SSA/P resection also poses challenges. The authors present examples of typical SSA/Ps that illustrate pitfalls and pearls in SSA/P detection and resection. This article is part of an expert video encyclopedia.

Colonic perforation at polypectomy of colorectal polyps is a rare but serious and typical complication. There are two major mechanisms for perforation: (1) immediate perforation due to mechanical slicing across the wall and (2) perforation due to thermal necrosis of the wall that leads to delayed perforation within a few hours after polypectomy. Immediate perforation during the procedure may be witnessed by the endoscopist and offers the option for direct endoscopic repair. We demonstrate a case with an iatrogenic perforation during endoscopic resection of a large laterally spreading tumor. This case illustrates the closure of a postpolypectomy perforation in the rectum with multiple metal clips. This article is part of an expert video encyclopedia.

Embryological development of the colon is complex and often unpredictable. This gives rise to variable colonic configurations during colonoscopy. An appreciation of normal colonic anatomy and three-dimensional spatial awareness of the estimated position of the colonoscope by the colonoscopist is important. Such understanding and awareness helps plan and institute specific maneuvers that are important for safe and complete examination, in addition to carrying out anatomically specific troubleshooting strategies in colonoscopy. This article is part of an expert video encyclopedia.

The double-duct sign, a simultaneous stenosis of the common bile duct and the pancreatic duct, is suggestive of the presence of a pancreatic cancer. Here the configuration by imaging with both endoscopic retrograde cholangiopancreatography and endosonography, in a case with pancreatic head carcinoma is demonstrated. This article is part of an expert video encyclopedia.