Video Journal and Encyclopedia of GI Endoscopy最新文献

Hyperplastic polyposis is a rare syndrome characterized by the development of multiple colorectal serrated lesions, most often a mixture of hyperplastic polyps and flat serrated adenomas. Patients with hyperplastic polyposis syndrome (HPS) have a high lifetime risk of developing colorectal cancer (up to 50%). However, at colonoscopy the diagnosis is often missed because the flat lesions are not recognized or the endoscopist is simply unaware of this syndrome. Here the author presents three cases with HPS and demonstrates the typical endoscopic features. This article is part of an expert video encyclopedia.

Chronic radiation-induced colonic injury occurs in up to 20% of patients following radiotherapy. The rectum and distal sigmoid colon are most susceptible to radiation damage, and chronic radiation proctopathy generally manifests with anorectal pain, diarrhea, rectal bleeding, and/or anemia. Endoscopic findings include loss of mucosal vasculature, patchy erythema, and angioectasia, which correlate with ischemic endarteritis of the submucosal arterioles, submucosal fibrosis, and angioectasia on histopathological examination. Although most patients develop symptomatic chronic radiation proctopathy within 1–2 years after radiation exposure, they can present up to 30 years after treatment. Radiation proctopathy, found incidentally during endoscopy, does not warrant any therapy. Argon plasma coagulation (APC) is the mainstay of endoscopic therapy for chronic radiation proctopathy. Laser therapy and dilute formalin (2–10%) application are associated with higher complications and are not commonly utilized. In this video presentation, endoscopic findings are described in chronic radiation proctopathy and colopathy as well as APC therapy. This article is part of an expert video encyclopedia.

In patients with jaundice and unsuccessful biliary drainage with cholangiopancreatography because of inaccessible papilla due to duodenal stenosis caused by tumor invasion, endoscopic ultrasound (EUS)-guided biliary drainage has been introduced as an alternative to percutaneous cholangiodrainage (PTCD). Here is demonstrated an EUS-guided choledochoduodenostomy in a patient with local advanced pancreatic carcinoma. This article is part of an expert video encyclopedia.

Colonic diverticulosis is one of the most common conditions in industrialized nations. At colonoscopy, passage of the sigmoid can be challenging and complex in patients with diverticulosis, especially when they harbor plenty and large diverticula. Large diverticular openings can mimic the colonic. We demonstrate the colonoscopic passage through a colon with massive diverticulosis. This article is part of an expert video encyclopedia.

This is a demonstration of endoscopic retrograde cholangiopancreatography and cholangioscopy with endoscopic placement of a biliary plastic stent in a 64-year-old woman with a first diagnosis of a cholangiocarcinoma classifed as Bismuth type I. The information presented here allows understanding of the precise technique needed for successful biliary stenting using straight plastic endoprosthesis. 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.

Confocal endomicroscopy is a new technique which provides real-time histological imaging of mucosa during endoscopy. Intravenous fluorescein is typically used to provide contrast. It distributes quickly within all compartments of the tissue and enables endomicroscopy within seconds of injection. This video describes the application of confocal endomicroscopy in the detection of suspicious lesions as well as sites where, previously, endoscopic mucosal resection (EMR) was done. This article is part of an expert video encyclopedia.

Endoscopic sphincterotomy is a basic technique that enables extraction of biliary stones by enlarging the papillary opening. However, it is also the most invasive procedure routinely performed by endoscopists and is associated with a considerable complication risk, especially when not properly performed. Here the author presents a case with jaundice and suspected biliary stones. Step-by-step explanation of the sphincterotomy and stone extraction technique with a basket is provided. Moreover, options for cannulating a floppy papilla are demonstrated. This article is part of an expert video encyclopedia.