DAVE Project – Gastroenterology

Shahzad Iqbal, MD, Columbia University Medical Center
Peter D. Stevens, MD, Columbia University Medical Center

A 65 years old gentleman who is status post transduodenal ampullectomy for tubular adenoma about three months ago, presented to us with on and off abdominal pain and elevated serum amylase and lipase levels. CT scan of the abdomen showed the pancreas to be unremarkable: however, a linear structure was noted inside the main pancreatic duct. Scout fi [...]

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

This is a 68 yr old Chinese man with a background history of Billroth II gastrectomy presented recently with a severe acute cholangitis. An ERCP was performed and a plastic stent was inserted for biliary drainage. He has now returned for a repeat ERCP. The initial duodenoscopic view showed only one small opening which we thought would most likel [...]

Bennett Hooks, MD, University of Texas Health Science Center San Antonio
Sandeep N. Patel, DO, University of Texas Health Science Center San Antonio

This 87-year-old female first presented to us with biliary obstruction 2 weeks after having aortic valve replacement. Plastic biliary stent was placed to relieve the obstruction and biopsies at the time revealed ampullary adenoma. Repeat ERCP with stent exchange and biopsies was performed confirming adenomatous tissue and EUS did not reveal any e [...]

Brett J. Partridge, MD, Naval Medical Center, San Diego

The pancreaticoduodenectomy, better known as the Whipple procedure, is performed for both benign and malignant indications. These include resectable pancreatic adenocarcinoma, mucinous neoplasms and neuroendocrine tumors. Long-term survival varies from 5-80%, largely based on the underlying indication for surgery. In a therapeutic endoscopy prac [...]

Harry Aslanian, M.D., Yale University

EUS guided probe confocal laser endomicroscopy (abbreviated pCLE) is performed in a feasibility study of three pancreas lesions, including a neuroendocrine tumor, adenocarcinoma and a solid-pseudopapillary neoplasm. 2.5 ml of 10% fluorescein was given intravenously as a contrast agent for pCLE imaging. The confocal probe was passed through a 1 [...]

Michael K Sanders, MD,

Experience with a prototype forward-viewing curvilinear array therapeutic echoendoscope for interventional EUS: a case series. Interventional EUS offers a minimally invasive alternative to traditional surgical and/or radiologic interventions for the treatment of pancreaticobiliary disorders. These procedures are typically performed with oblique [...]

Elie Aoun, MD, University of Pittsburgh

This video aims to demonstrate the EUS-assisted access to a peripancreatic abscess and subsequent drainage into the stomach in addition to the use of hydrogen peroxide to facilitate removal of necrotic debris. A 26 year old female patient presented with LUQ abdominal pain of two months duration. Her past medical history was significant for obesi [...]

Peter D. Stevens, MD, Columbia University Medical Center
Shahzad Iqbal, MD, Columbia University Medical Center

Pancreas divisum is a congenital abnormality that is seen in upto 7% of patients undergoing ERCP. It results from lack of fusion of ventral and dorsal pancreatic ducts. As shown in the MRCP images, the CBD and main PD do not join at major ampulla. This video will demonstrate the technique of endoscopic treatment of pancreas divisum. Ventral pan [...]

Harry Aslanian, M.D., Yale University

A 33 yo female underwent imaging of the abdomen with a CT scan of the abdomen to evaluate abdominal pain. A mass in the tail of the pancreas with increased uptake on octreotide scan was identified. EUS identified a well circumscribed, 3 cm mass superior to the kidney in the pancreas tail. A central cystic space was seen within the mass along wit [...]

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

83 year old male with multiple co-morbidities presented with fever, abnormal liver enzymes and dilated common bile duct (CBD) up to 15 mm in size on abdominal CT scan and elevated international normalized ratio (INR). A pull type sphincterotome was used to cannulate the common bile duct. After the slight adjustment, the sphincterotome was advance [...]