DAVE Project – Gastroenterology

Todd H. Baron, M.D., Mayo Clinic

This is an elderly patient who presented with massive hematemesis. The patient was resuscitated and admitted to the intensive care unit. An upper endoscopy was performed which revealed active oozing from a lesion on the anterior wall of the duodenal bulb. This was initially thought to be an ulcer with a visible vessel but due to the position and [...]

Michael Piesman, M.D., Massachusetts General Hospital
Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital

A 68-year-old man with a history of metastatic pancreatic carcinoma presented with a gastric outlet obstruction and was referred for enteral stenting. Gastroscopy revealed a marked stenosis in the first portion of the duodenum from extrinsic compression. The first step in stenting such a stenosis is to pass a wire safely through the area. One metho [...]

Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital

This 45 year old man presented with the acute onset of melena and a hematocrit of 17%. His endoscopy reveals this mid duodenal ulcer which has several notable features. Most striking are the heaped up and eroded edges which dip into the broad and diffusely ulcerated vulcanized base. These features are suggestive of malignancy. This man's hist [...]

Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital
Robert H. Schapiro, M.D., Harvard Medical School, Massachusetts General Hospital

The prominent white speckles seen in the enterocytes lining the duodenum represent lymph in dilated lymphatics. Lymphatic congestion can be seen normally to a mild degree postprandially and in a variety of conditions that increase central venous pressure such as congestive heart failure. When seen to this degree, however, the diagnosis of Chronic I [...]

Gottumukkala S. Raju, MD, MD Anderson Cancer Center
Jeeathbell Balbastro, M.D., University of Texas Medical Branch

This is a 62yo man with h/o chronic diarrhea who was found to have severe osteoporosis on CXR with evidence of compression fracture of one of the mid thoracic vertebral bodies, was referred to GI for evaluation of celiac disease. On EGD you can see erythema and scalloping of the descending duodenum, you can also see more diffuse scalloping and and [...]

Anthony Kalloo, M.D., Johns Hopkins Medical Center

This is a demonstration of argon plasma coagulation (APC) used to treat duodenal polyposis in a patient with familial adenomatous polyposis (FAP). She has had a previous ampullectomy and endoscopic laser therapy for treatment of her duodenal polyposis. Prior histology of the duodenal polyps demonstrated adenomas without dysplasia. APC is a non [...]

Anthony Kalloo, M.D., Johns Hopkins Medical Center

This is a demonstration of the use of 3% hydrogen peroxide to improve the visualization of the source of bleeding in patients with upper GI hemorrhage. 3% H2O2 causes oxidation of red blood cells resulting in lysis of the cells, making blood translucent and improving visualization. Since there is significant effervescence when blood is mixed with h [...]

Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital

This 49 year old lady has had a one year history of worsening diarrhea of up to 8-10 bowel movements per day. Prior serologic studies suggested the possibility of sprue. This endoscopy demonstrates changes that are very suggestive of sprue also called gluten sensitive enteropathy or celiac disease. The classic endoscopic features are seen here; th [...]