Video Journal and Encyclopedia of GI Endoscopy最新文献

Background

Zollinger–Ellison (ZE) syndrome is characterized by gastric acid hypersecretion and ulcer disease from autologous gastrin secretion by a gastrinoma.

Patient and methods

A 43 year old man underwent upper endoscopy for a 6 week history of recurrent nausea, vomiting, heartburn, weight loss, and watery diarrhea.

Results

Endoscopic findings included severe reflux esophagitis with multiple linear esophageal ulcerations, thickened gastric folds with mosaic pattern mucosa, distinctive gastric corpus and antrum junction, numerous antral erosions with traces of coffee ground substance, bulbar erosions and ulcerations, and post-bulbar erosions and ulcerations. Based on these symptoms and endoscopic findings, a gastrinoma work-up was instituted and the diagnosis was confirmed.

Conclusions

Endoscopists need to be aware of the classical symptoms and clinical findings associated with ZE syndrome in order to appropriately diagnose and manage affected patients.

Recently, colorectal endoscopic submucosal dissection (ESD) obtained official approval as a standard treatment procedure in Japan. Colorectal ESD is technically more difficult and risky than gastric ESD. However, by understanding the anatomical obstacles in colorectal ESD and using proper methods and tips to overcome the difficulties, ESD is a feasible and useful treatment method for early colorectal neoplastic lesions as well. In this video, technical details of colorectal ESD using a Safe Knife are presented. This article is part of an expert video encyclopedia.

Adenomas involving the major duodenal papilla are being recognized more frequently as a result of the increased use of diagnostic upper endoscopy. They have the potential to progress from benign to malignant lesions and should be resected completely. Endoscopic ampullectomy as curative therapy has gained credibility as a safe and effective alternative to surgical resection. This is a demonstration of a wire-guided ampullectomy of a low-grade adenoma. Step-by-step information is provided for safe endoscopic ampullectomy with subsequent prophylactic pancreatic stenting. This article is part of an expert video encyclopedia.

Videos are presented showing the technique of endoscopic mucosal resection (EMR) of large and difficult polyps carried out by the authors at their center, which is also a referral center for EMR of large and flat polyps, difficult polyps, and partially removed polyps. Most of the procedures are done in an outpatient setting under monitored sedation. The center has a large database of polyps removed by EMR. Its faculties are active in EMR-related research and have many recent publications in this area. The purpose of this instructional video is to teach EMR of large and difficult polyps to gastroenterologists. This article is part of an expert video encyclopedia.

Endoscopic transpapillary gallbladder drainage for symptomatic gallbladder disease is a safe and effective bridge therapy in patients at high risk for surgery or who have terminal liver disease awaiting transplantation. However, there are few reports on long-term results in terms of stent patency and clinical course. We investigated the long-term patency and clinical course after endoscopic transpapillary gallbladder stenting (ETGS) in patients who were unsuitable for cholecystectomy with symptomatic gallbladder disease. ETGS using a 7 F double-pigtail stent between the gallbladder and the duodenum was performed successfully in 79.3% in our institutions. Postprocedure complications were mild pancreatitis (8.7%) and cholestasis (8.7%), all of which resolved with conservative management. During the follow-up period (median 586 days, range 11–1403 days), median stent patency was 760 days, as determined by the Kaplan-Meier method. As a primary therapy, ETGS is technically feasible and provide long-term stent patency without the need for scheduled stent exchanges in patients who are unsuitable for cholecystectomy. This article is part of an expert video encyclopedia.

Choledocholithiasis is usually treated by endoscopic retrograde cholangiography (ERC) and stone extraction with the help of a stone extraction basket or balloon. In cases of giant or incarcerated stones, a normal stone extraction is not always successful. In these cases, it can be necessary to perform a stone fragmentation to remove the stone. Stone fragmentation can be performed mechanically with a stone fragmentation basket, with extracorporeal shock wave lithotripsy, electrohydraulic lithotripsy, or laser lithotripsy. The performance of a mechanical lithotripsy is widely spread, it is easy to perform and cost effective.¹

The authors present a case of a patient who underwent an ERC procedure for mechanical lithotripsy of a giant stone that could not be retrieved in the traditional way. This article is part of an expert video encyclopedia.

Knowledge of normal endoscopic ultrasound (EUS) anatomy is the basis for orientation in EUS. Therefore, training in important anatomical landmarks is mandatory for each endosonographer. The main message of the video of this article is ‘how to find the anatomical guiding structures in the upper abdomen’ in radial and longitudinal EUS. This article is part of an expert video encyclopedia.

Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. The main complications during ESD comprise perforation and bleeding. For the standardization of ESD, it is most important to prevent these complications. Adopting a safe strategy of ESD, the use of hyaluronic acid for injection solution, and a suitable choice of knife are efficient in the prevention of perforation and bleeding. In this article, the authors describe a safe procedure of ESD to prevent complications, especially perforation and bleeding. This article is part of an expert video encyclopedia.