DAVE Project – Gastroenterology

Jonathan Buscaglia, MD, Stony Brook University Medical Center
Parantap Gupta, MD, Stony Brook University Medical Center

A 56 year old man with malignant duodenal obstruction presents with recurrent nausea and vomiting. The endoscope is not able to be passed through the existing duodenal stent. Both the duodenal stent and the previously placed biliary stent can be seen. A standard biliary extraction balloon is passed through the narrowed lumen of the previously place [...]

Jose Alberto Gonzalez-Gonzalez, MD, Centro Reginal de Enfermedades Dijestivas, UANL, Monterrey, Mexico
Genaro Vazquez-Elizondo, MD, Centro Reginal de Enfermedades Dijestivas, UANL, Monterrey, Mexico

A 24 year old male patient with hematemesis was evaluated in the emergency room. One year previously he had sustained an abdominal gunshot complicated with an aortic infra-renal pseudo-aneurysm that required placement of an aortic Dacron knitted graft. The physical examination upon admission was unremarkable. An upper endoscopy was performed, but t [...]

Harry Aslanian, M.D., Yale University
Manmeet Padda, MD, Yale University

A 50 year old male with chief complaint of post-prandial vague abdominal pain had a capsule endoscopy exam, which showed submucosal mass in the proximal small bowel. Upper endoscopy showed a 2 cm submucosal bulge in the third portion of the duodenum occupying 1/4th of the lumen with normal overlying mucosa. This lesion was soft and collapsed some [...]

Rajesh N. Keswani, MD, Washington University
Steven A. Edmundowicz, MD, Washington University

A 24 year old female was referred for complaints intermittent nausea and vomiting and weight loss. The upper GI barium study demonstrates an enlarged diverticulum in the second portion of the duodenum. A thin radiolucent stripe is seen around the diverticulum which has been described as the halo sign. Upper endoscopy is performed which identifies a [...]

Mohammad Bilal, Harvard Medical School
David G. Forcione, M.D., Harvard Medical School, Massachusetts General Hospital
Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital

During a routine endoscopy for Barrett's related dysplasia surveillance, this mucosal abnormality was identified. On endoscopy, these pigmented areas of mucosa in the antrum, pylorus, and duodenum were seen. This is the classic endoscopic finding of pseudomelanosis of the gastrointestinal tract, whose features include a brownish-black pigmen [...]

Chandra S. Dasari, MD, MD Anderson Cancer Center
Gottumukkala S. Raju, MD, MD Anderson Cancer Center

The following video demonstrates the endoscopic view of a duodenal ulcer and a look at its pathogenesis by reviewing The leaking roof concept by C. S. Goodwin. The most important causative factor for a duodenal ulcer is Helicobacter pylori. Endoscopic view of a DU. The endoscope is in the duodenum. Retracting the scope from the second part of [...]

William R. Brugge, M.D., Harvard Medical School, Massachusetts General Hospital

Duodenum – carcinoid tumor, with EUS FNA This is a 54 yo female with known chronic liver disease who underwent upper GI endoscopy and a small carcinoid lesion was found in the duodenum. On this examination we see a smooth, round, superficial, subepithelial lesion with some central dimpling. The findings are consistent with a neuroendocrine [...]

Cynthia Leung, MD, Palo Alto Veteran’s Hospital, Stanford University School of Medicine
Roy Soetikno, M.D., Palo Alto Veteran’s Hospital, Stanford University School of Medicine
Shai Friedland, M.D., Palo Alto Veteran’s Hospital, Stanford University School of Medicine

A 73 yo man presented with a three day history of hematemesis. Three days prior, he began vomiting red blood, progressively larger in quantity. His past medical history was most notable for CAD, atrial fibrillation (off coumadin), and renal cell carcinoma. 8 months prior to presentation the patient underwent embolization and right nephrectomy fo [...]

Chang Keun Park, M.D., Daegu Fatima Hospital, Korea
Jimin Han, MD, Daegu Fatima Hospital, Korea
Ho Gak Kim, MD, Daegu Fatima Hospital, Korea

Primary intestinal lymphangiectasia is a rare congenital disorder of lymphatic system. This is characterized by abnormally dilated lymphatic and excessive enteric loss of lymph fluid rich in plasma protein, chylomicron and lymphocytes. So far, suggested mechanisms of lymphatic fluid loss are exudation from the epithelium and rupture of dilated ly [...]

Dirk Domagk, MD, University of Muenster
Philip Lenz, M.D., University of Muenster
Christian Wulfing, MD, University of Muenster
Thorsten Pohle, MD, University of Muenster
Wolfram Domschke, MD, University of Muenster
Torsten Kucharzik, MD, University of Muenster

Bouveret''s syndrome was first described by Bartolin in the 17th century as disease of elderly and debilitated people. In the 19th century, French physician Leon Bouveret described a syndrome of gastric outlet obstruction – caused by an impacted gallstone in the duodenal bulb after migration through a cholecysto- or choledocho-duodenal fist [...]