DAVE Project – Gastroenterology

Satish Nagula, MD, Stony Brook University Medical Center
Jonathan Buscaglia, MD, Stony Brook University Medical Center

This is a 61 year old female with a history of pancreatic CA, s/p pylorus preserving Whipple, chemotherapy and radiation 20 years prior. She clinically has no evidence of disease. She has a 2 yr history of recurrent attacks of severe abdominal pain. These attacks of pain were self-limited episodes that lasted several hours. She was ultimately a [...]

Haritha Avula, MD,

Our patient is a 55 year old woman presenting with intermittent episodes of periumbilical abdominal pain and nausea of 2 months duration. She had extensive prior history of abdominal surgeries including ovarian cancer resection complicated by colonic perforation. This was treated with segmental colonic resection and temporizing ileostomy. Subsequ [...]

Manuel Perez-Miranda, MD,

Biliopancreatic diversion is a morbid obesity surgery in which a long afferent loop is anastomosed to the ileum. It makes peroral ERCP impossible. Intraoperative ERCP through the distal antrum is feasible, and convenient if cholecystectomy is needed. A 72 y.o. female had prior cholecystectomy and biliopancreatic diversion with gastrectomy. She w [...]

Takao Itoi, MD, PhD, Tokyo Medical University

ERCP in patients with surgically altered anatomy, in particular Roux-en-Y anastomosis, can be more challenging. The use of balloon overtube-assisted enteroscopy can be useful for ERCP in patients with such surgically altered anatomy. Even using an enteroscope, removing large or multiple stones can be often difficult and time-consuming. Several en [...]

Juan Carlos Bucobo, M.D., Cedars-Sinai Medical Center

Increased prevalence of morbid obesity has resulted in an increased frequency of Roux-en-Y gastric bypass. Investigation of pancreatic and biliary complaints following roux-Y gastric bypass is difficult secondary to rerouting of the small bowel, a long intestinal limb and limited access to the major papilla; previously only achieved by surgical [...]

Douglas A. Howell, M.D., Maine Medical Center

Fiber optic and video baby-scopes have been available for many years; however limitations have included fragility, use in ducts less than 10Fr in size, high cost and time spent. This study is to look at a recently introduced reusable fiber optic bundle which will fit through standard ERCP accessories. We wish to examine smaller ducts and see if t [...]

Manmeet Padda, MD, Yale University
Uzma Siddiqui, M.D., Yale University
Harry Aslanian, M.D., Yale University
Priya A. Jamidar, MD, Yale University

A 65 year old female had multiple episodes of recurrent acute pancreatitis. Endoscopic ultrasound (EUS) examination showed pancreas divisum. From the second portion of the duodenum, the slow withdrawal of the endoscope was performed to visualize the minor papilla. Minor papilla examination was performed in the long position of the endoscope, whi [...]

Kapil Gupta, M.D., Hennepin County Medical Center, University of Minnesota

In this video we will present two cases discussing the technique of bile duct access with pure wire guided cannulation using a loop tip guide wire. For pure wire guided cannulation, a sphincterotome is recommended. We should stay slightly away from the papilla so that papilla is clearly visualized and using the bow of sphincterotome the guide wir [...]

Shyam S. Varadarajulu, MD, University of Alabama at Birmingham

1. This video demonstrated a case of endoscopic resection of a distal bile duct mass. 2. A 76-yr old patient with recurrent cholangitis under went EUS for evaluation of a dilated bile duct. 3. At EUS, a hyperechoic mass was seen in the distal CBD consistent with a polyp. 4. An ERCP was undertaken to evaluate the mass by intraductal ultras [...]

Gregory A. Cote, MD, MS, University of Washington

Direct, peroral cholangioscopy in the management of refractory stone disease, presented by Gregory Cote, Steven Edmundowicz, Sreenivasa Jonnalagadda and Riad Azar. Cholangioscopy allows direct visualization of the bile duct; this has been used to distinguish malignant from benign bile duct lesions, as wall as in the management of complicated choled [...]