DAVE Project – Gastroenterology

Ara B. Sahakian, MD, Yale University
Harry Aslanian, M.D., Yale University
James Ostroff, MD, University of California, San Francisco
Priya A. Jamidar, MD, Yale University

Pancreatic duct stents are useful in reducing the risk of post-ERCP pancreatitis. Risks of placing pancreatic duct stents include internal migration, difficult or failed placement, and ductal damage. Improper placement of pancreatic duct stents can predispose to migration. Removal of internally migrated pancreatic duct stents can be technically cha [...]

Sandeep T. Samuel, MD, University at Buffalo, Buffalo, NY
Neil Wilkinson, MD, Roswell Park Cancer Institute, Buffalo, NY
Kanheira Kazunouri, MD, Roswell Park Cancer Institute, Buffalo, NY
Andrew J. Bain, MD, Roswell Park Cancer Institute, Buffalo, NY

A 67-year-old male presented with left upper quadrant abdominal pain of one month duration. A CT scan showed a 3 cm cystic lesion with internal fat content arising from the tail of pancreas. The CA 19-9 level was within normal reference range at 8.4 U/mL. Patient was referred to our institution for further evaluation with endoscopic ultrasound. [...]

Martin L. Freeman, M.D., University of Minnesota

The first patient had two failed attempts at minor papilla access at an expert center, in the setting of acute recurrent pancreatitis. There was no visual clue as to the whereabouts of the minor papilla. That clip at the bottom was from a prior biliary sphincterotomy bleed over one year earlier. In this case, it is indispensable to spray methylene [...]

Andrew J. Bain, MD, University of California San Diego
Suresh Pola, MD, University of California San Diego, Veterans Affairs San Diego Medical Center
Thomas Savides, MD, University of California San Diego

A 54 year old female underwent upper endoscopy at an outside facility for evaluation of dyspepsia showing a subepithelial gastric mass. Mucosal biopsies were non-diagnostic. The patient was referred to our center for endoscopic ultrasound and further tissue sampling. Upper endoscopy showed a 1 cm subepithelial mass in the gastric antrum locate [...]

Prashant Kedia, MD, Mount Sinai Medical Center
Ron Lee, MD, Mount Sinai Medical Center
Kalpesh Patel, MD, Mount Sinai Medical Center
Michelle Kim, MD, Mount Sinai Medical Center

A 41 year old surgeon presented with several months of epigastric pain. A CT scan was performed which revealed multiple masses in the liver, the largest of which measured approximately 7.4 cm in diameter. Some of these lesions demonstrated high peripheral density suggestive of calcification; no obvious pancreatic mass was noted. A CT guided biop [...]

Patrick Yachimski, MD, Vanderbilt University Medical Center

The patient is an 84 year old male who had previously been diagnosed with a main duct IPMN involving the pancreatic head. The patient had opted for expectant management in lieu of surgical resection, and had been relatively asymptomatic for 2 years, until presenting with jaundice, cholangitis, and gram negative sepsis. An abdominal CT demonst [...]

Charles Chaya, MD, Kaiser Permanente Riverside Medical Center
Albert Ko, MD, Kaiser Permanente Riverside Medical Center
Mark Taira, MD, Kaiser Permanente Riverside Medical Center
Jane Tongson-Ignacio, MD, Southern California Permanente Medical Group Regional Laboratory
Brian S. Lim, MD, Kaiser Permanente Riverside Medical Center

60 year old female presented with episodes of hypoglycemia with glucose in the range of 55 to 63. Her symptoms included night sweats and confusion during the day time for which patient would eat peanut butter with improvement. Symptoms were worse with exercise. Patient was found to have high insulin level of 20 (normal 3 – 11 mU/L). C-peptide [...]

Dr. Quan Wai Leong, Tan Tock Seng Hospital, Singapore

Endoscopic ampullectomy has been considered a high risk procedure associated with a higher complication rate of bleeding, perforation and pancreatitis compared to conventional ERCP. Much effort has been spent on using different technique, equipment and different power settings of the electrosurgical unit in an attempt to minimize complications. T [...]

Gottumukkala S. Raju, MD, MD Anderson Cancer Center
Sathya Jaganmohan, MD, University of Texas Medical Branch
Jeffrey H. Lee, MD, MD Anderson Cancer Center

In this EUS Learning Series, the next step is Linitis Plastica. A 55 year old man is referred for evaluation of gastric cancer diagnosed at an outside facility. He had undergone EGD, EUS and probe sonography; a diagnosis of Linitis Plastica was made. We would like to show stomach anatomy in health and in Linitis Plastica to appreciate the features. [...]

David Arner, MD, University of Virginia
Bryan Sauer, MD, University of Virginia
Vanessa Shami, MD, University of Virginia

A 41 year-old female presented to her primary care physician with back pain. Abdominal CT revealed a heterogeneous cystic mass in the body of the pancreas measuring 5.8 x 5.3 x 4.9 cm. Further evaluation with endoscopic ultrasound (EUS) revealed a 5cm multiseptated grossly solid cystic lesion consistent with a pseudopapillary neoplasm. After color [...]