DAVE Project – Gastroenterology

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

A 54 year old male was referred due to gastric submucosal lesions seen on the recent endoscopic examination. Endoscopic examination of the stomach showed multiple, nodular lesions predominantly involving the antrum and distal body. A bi-lobed mass like area was seen at the angularis with normal looking overlying mucosa. A small, clean based ulcer [...]

Mohammad Bilal, Army Medical College, National University of Science & Technology, Pakistan
Muhammad Umar, Holy Family Hospital, Rawalpindi, Pakistan
Hamama tul-Bushra, Holy Family Hospital, Rawalpindi, Pakistan

This abnormality was encountered on upper Endoscopy of this 35 year old female who complained of Epigastric pain and Dyspepsia. This worm is Ascaris lubricoides – the most common of the intestinal nematodes. Measuring 15-35cm in length. When ingested, unfertilized eggs are not infective. Fertile eggs embryonate and become infective after 18 d [...]

Jonathan Buscaglia, MD, Stony Brook University Medical Center

A 49 year-old man underwent a recent esophagectomy for esophageal cancer. His postoperative course was complicated by a fistula between the trachea and the intra-thoracic stomach. A previously placed tracheal stent was unsuccessful at sealing the fistula. Using argon plasma coagulation, the perimeter of the opening is ablated in order to de-epithel [...]

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

The obesity epidemic now affects 30% of the adult population in the U.S., approximately 60 million Americans. Bariatric surgery remains the most effective treatment to date. Endoluminal therapies present an opportunity for a less invasive approach. Transoral gastroplasty, or TOGA, combines two flexible, endoscopic staplers that can be used to [...]

Horst Neuhaus, MD, University of Duesseldorf

We report on endoscopic submucosal dissection with a water-jet HybridKnife (ESDH) of mucosal and submucosal lesion in the upper GI tract This animation shows the principle of ESDH. The tipof the HybridKnife is used for setting coagulation markers with safety margins around the targeted lesion. The knife is then positioned close to some of the [...]

Andres Sanchez-Yague, MD, PhD, California Pacific Medical Center

Bleeding from gastric varices is associated with significant morbidity and mortality. Management of bleeding gastric varices is difficult due to their large size and the severity of bleeding. Treatment options include creatin of a porto-systemic shunt by means of TIPS or surgery and endoscopic interventions. A 43-year-old male with a past m [...]

Kenneth F. Binmoeller, MD, California Pacific Medical Center

Although GISTS comprise only 1% of gastrointestinal tract tumors, two-thirds are located in the stomach, constituting 5% of gastric tumors. It is estimated that between 5- 6,000 new cases are diagnosed per year. This number will increase as more GISTS are found incidentally on upper endoscopy. EUS plays a crucial role in the evaluation, diag [...]

Arnab Biswas, DO, Penn State Milton S. Hershey Medical Center

Background 1 Endoscopic necrosectomy of complicated pancreatic pseudosustic collections have been demonstrated to be a safe primary treatment of necrosis and abscess collections. 2 Transgastric access technique has revolutionized the role of interventional endoscopy in a variety of cases where surgery is too risk or contraindicated. 3 We desc [...]

Eun J. Shin, MD, Johns Hopkins Medical Center
Anne Marie Lennon, MD, Johns Hopkins Medical Center
Patrik I. Okollo III, MD, MPH, Johns Hopkins Medical Center

This is a case of a 47 year-old female with metastatic colon adenocarcinoma who was admitted with intractable nausea and vomiting with per oral intake. Upper GI study abdominal CT scan demonstrated a small bowel obstruction with a transition point in the proximal-mid jejunum. She was deemed to be a poor operative candidate and the decision was m [...]

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

CT scan performed to evaluate pneumonia in a 75 year old female identified a large gastric mass. The patient had no upper intestinal symptoms. EGD revealed a large, smooth, rounded mass occupying most of the fundus with a mosaic appearance of the overlying mucosa. The mass was arising from the fundus, noted to be at the same location as an 8 mm [...]