Background and aims: Novel endoscopic techniques have been developed as effective treatments for obesity. Recently, reduction of gastric volume via endoscopic placement of full-thickness sutures, termed endoscopic sleeve gastroplasty (ESG), has been described. Our aim was to evaluate the safety, technical feasibility, and clinical outcomes for ESG. Patient and methods: Between August 2013 and May 2014, ESG was performed on 10 patients using an endoscopic suturing device. Their weight loss, waist circumference, and clinical outcomes were assessed. Results: Mean patient age was 43.7 years and mean body mass index (BMI) was 45.2?kg/m(2). There were no significant adverse events noted. After 1 month, 3 months, and 6 months, excess weight loss of 18?%, 26?%, and 30?%, and mean weight loss of 11.5?kg, 19.4?kg, and 33.0?kg, respectively, were observed. The differences observed in mean BMI and waist circumference were 4.9?kg/m(2) (P?=?0.0004) and 21.7?cm (P?=?0.003), respectively. Conclusions: ESG is effective in achieving weight loss with minimal adverse events. This approach may provide a cost-effective outpatient procedure to add to the steadily growing armamentarium available for treatment of this significant epidemic.
Endoscopic retrograde cholangiopancreatography (ERCP) is currently the preferred procedure for biliary drainage in both benign and malignant obstructions. While ERCP is successful in approximately 95 % of cases, a small subset of cases are unsuccessful due to variant anatomy, ampullary pathology, or malignant luminal obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a promising route for biliary decompression that provides multiple advantages over percutaneous and surgical biliary drainage. Multiple retrospective as well as some prospective studies have shown EUS-BD to be safe and effective. Based on the current literature, the cumulative success rate is 84-93 %, regardless of the approach, with an overall complication rate of 16-35 %. EUS-BD appears to a viable therapeutic modality for failed ERCP when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and biliary endoscopy. Larger prospective multicenter randomized comparative studies are needed to further define indications, outcomes, and complications.
Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure.
The value of performing comprehensive screening colonoscopy with complete colon polypectomy is widely accepted. Colon cancer is a significant cause of worldwide mortality and prospective studies have proven that colonoscopic polypectomy reduces both the incidence and mortality related to this disease. Over the past few decades the array of instruments and techniques have greatly expanded to assist with the safe endoscopic removal of colon polyps. This article will review the published literature regarding efficacy and safety of standard polypectomy techniques such as snare polypectomy, electrocautery, and endoscopic mucosal resection along with newer techniques such as endoscopic submucosal dissection and combined laparoscopic techniques.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is one of the least invasive and most effective modality in diagnosing pancreatic adenocarcinoma in solid pancreatic lesions, with a higher diagnostic accuracy than cystic tumors. EUS-FNA has been shown to detect tumors less than 3 mm, due to high spatial resolution allowing the detection of very small lesions and vascular invasion, particularly in the pancreatic head and neck, which may not be detected on transverse computed tomography. Furthermore, this minimally invasive procedure is often ideal in the endoscopic procurement of tissue in patients with unresectable tumors. While EUS-FNA has been increasingly used as a diagnostic tool, most studies have collectively looked at all primary pancreatic solid lesions, including lymphomas and pancreatic neuroendocrine neoplasms, whereas very few studies have examined the diagnostic utility of EUS-FNA of pancreatic ductal carcinoma only. As with any novel and advanced endoscopic procedure that may incorporate several practices and approaches, endoscopists have adopted diverse techniques to improve the tissue procurement practice and increase diagnostic accuracy. In this article, we present a review of literature to date and discuss currently practiced EUS-FNA technique, including indications, technical details, equipment, patient selection, and diagnostic accuracy.
Currently, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for biliary drainage for various pancreatico-biliary disorders. ERCP is successful in 90% of the cases, but is unsuccessful in cases with altered anatomy or with tumors obstructing access to the duodenum. Due to the morbidity and mortality associated with surgical or percutaneous approaches in unsuccessful ERCP cases, biliary endoscopists have been using endoscopic ultrasound-guided biliary drainage (EUS-BD) more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that incorporates various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS-BD techniques. Indications for EUS-BD include failed conventional ERCP, altered anatomy, tumor preventing access into the biliary tree and contraindication to percutaneous access (i.e., ascites, etc.). EUS-BD utilizing EUS-guided rendezvous technique is conducted by creating a tract from either the stomach or the duodenum into the bile duct. Although EUS-BD has rapidly been gaining attraction and popularity in the endoscopic world, the indications and methods have yet to be standardized. There are several access routes and techniques that are employed by advanced endoscopists throughout the world for BD. This article reviews the indications and currently practiced EUS-BD techniques, including indications, technical details (intrahepatic or extrahepatic approach), equipment, patient selection, complications, and overall advantages and limitations.
The performance of colon polypectomy has proven to be one of the most impactful services provided by todays endoscopist. Advancements in instrumentation and endoscopic techniques have been studied intensely by endoscopists over the past decade in order to expand their extent of resection capabilities to large and complex polyps. Much of the research in the past year has focused on the safety and efficacy of performing endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and combined laparascopic-endoscopic resections (CLER). Experts have published case-series, multicenter studies, and even nationwide results on the use of these methods for complex polypectomy. Because of the novelty and increased risk of these procedures, recent research has also focused on the prevention, identification and management of complications related to polypectomy, particularly bleeding and perforation. This manuscript will review the recent literature addressing basic and advanced colon polypectomy techniques.
BACKGROUND: The incidence of microscopic colitis (MC) is increasing, but its etiology remains unknown. Case reports and limited controlled data suggest that commonly prescribed drugs may be triggers. The aim of this study was to evaluate the prevalence of selected medication use [Proton pump inhibitors (PPIs), HMG-CoA reductase inhibitors (statins), and Selective serotonin reuptake inhibitors (SSRIs)] in patients with MC compared to random controls and diarrhea controls. METHODS: All patients were selected from primary care practices of a university health system during 2002 to 2007. Patients with biopsy proven lymphocytic or collagenous colitis were identified as cases. Diarrhea controls consisted of a 10:1 random sample of patients with chronic diarrhea and normal colon biopsies. Ten random controls were matched to each case on sex and index date (date of biopsy proven diagnosis). Drugs prescribed within the year prior to the index date were collected from the electronic medical record system. RESULTS: 26 cases (median age 68.9 yrs), 259 random, and 259 diarrhea controls were identified. The adjusted ORs for PPI, SSRI, and statin prescription within 12 months of diagnosis of MC between cases and diarrhea controls were 0.28 (0.07-1.07), 0.87 (0.28-2.64), 1.12 (0.34-3.71) respectively. Use of PPI and statins was less common in MC patients than in random controls (p<0.05 for both comparisons). CONCLUSIONS: While prior data suggest that PPIs, statins, and SSRIs may be etiologically related to MC, our study found no increased association with these drugs.
Sporadic duodenal adenomas (SDA) are mucosal neoplasms with malignant potential. Endoscopic eradication used both resection and ablation techniques. Optimal predictors, tools, and techniques for endoscopic eradication of SDA have not been determined.
There is limited data on the impact of capsule endoscopy (CE) findings on patient outcomes. The aim of our study is to evaluate the impact of CE findings on further diagnostic work-up, treatment, and symptom resolution.
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