Instructional Cases

Below are videos that illustrate unique cases and techniques in gastrointestinal endoscopy. Feel free to leave a comment with any questions.

Endoscopic Removal of a Curtain Hook Impacted in the Esophagus

Managing foreign bodies in the GI tract requires understanding what the object looks like and being careful not to injury the intestinal tract. Overtubes are preferable to use but the size of some objects may not allow this.

A 50 year old woman was transferred from an outside hospital with a history of swallowing a curtain hook at her psychiatric facility. Chest x-ray demonstrates two sharp edges, one facing towards the mouth and one on the gastric side. Endoscopic removal is requested with surgical back-up. Patient was discharged the next day after normal esophagram.

Avoiding Unnecessary Surgery

This 60 year old female had a screening colonoscopy at her local hospital. The endoscopist identified this polyp as suspicious for carcinoma, tattooed it, and biopsied it. Pathology was an inflammatory polyp. Surprisingly, she was referred for surgery and the surgeon recommended a right hemicolectomy. She correctly sought another opinion and her surgeon at our institution referred her for endoscopic resection. Final pathology of this 2 cm pedunculated polyp is a retention polyp. This is an entirely benign polyp.

Needle Knife Sphincterotomy

Generally, biliary access can be achieved with standard cannulation techniques. However, in some cases, other techniques may be required. This is a case where biliary access can not be achieved and a PD stent can not be placed to facilitate cannulation. Therefore, a freehand pre-cut sphincterotomy is performed for biliary access.

Removing a Retained Video Capsule

A 30 year old female underwent video capsule endoscopy for anemia. The capsule did not reach the cecum and follow-up radiographs confirm it is retained in the suspected jejunum. Peroral enteroscopy is performed to identify the cause of capsule retention and retrieve the capsule.

Endoscopic Management of Chronic Pancreatitis

Endoscopic therapy for chronic pancreatitis can be particularly effective in the presence of large duct chronic pancreatitis. Although surgery is more durable, many patients choose to undergo endoscopic therapy. This is an example of a 33-year old patient with chronic calcific pancreatitis from hereditary pancreatitis and a very distal PD stricture.

Endoscopic closure of duodenotomy after surgical removal of impacted duodenal gallstone.

Young male with Bouveret’s syndrome who had attempted operative management at an outside institution of gallstone ileus with a large stone obstructing the duodenum. The closure of the duodenotomy had a large dehiscence with over 1L of bilious output daily through JP drain. Over-the-scope clip closure was attempted and successful.

Cystic Duct Stone Cholangioscopy and Electrohydraulic Lithotripsy (EHL)

Cholangioscopy can be used to better evaluate bile duct strictures and can also be used to provide directed treatment to bile duct stones. A retained cystic duct stone can be particularly difficult to treat. In this case, EHL is used via cholangioscopy to treat biliary colic from cholecystolithiasis after cholecystectomy.

Fixing the Problems You Create

Sometimes iatrogenic complications are the hardest to treat. In this case, single balloon enteroscopy was used to locate the source of bleeding in a patient with an abnormal video capsule endoscopy after pancreas transplant. A non-bleeding ulcer was seen and biopsied. Bleeding control was ultimately needed.

Endoscopic Mucosal Resection of an Advanced Colon Neoplasm

Detectiona and Removal of flat lesions in the ascending colon can be complex, but these lesions are arguably the most important to remove given the higher risk of advanced neoplasia.
Endoscopic removal requires an excellent submucosal lift and an appropriate snare. Clip closure may reduce risk of postpolypectomy bleeding.

Endoscopic Removal of a Migrated Cystic Duct Clip into CBD

Interesting case of a cholecystectomy clip migrating into the distal CBD causing symptoms of biliary colic. Removal is made more difficult due to prior roux-en-y anatomy from gastric bypass.