Endoscopic sleeve gastroplasty: live uncut procedure

A 78-year-old man presenting with chronic renal failure was admitted to the emergency department of our hospital for bleeding per rectum.
The hemoglobin level was 10.5 g/dL on admission. Given that the patient was hemodynamically stable, decision was made to perform an upper GI endoscopy and a total colonoscopy the following day after standard bowel preparation. Bleeding recurred during the night with a hemoglobin drop to 6.3g/dL, requiring transfusions of 3 Units of blood.
With no further delay, endoscopy was performed. The gastroscopy was normal but at colonoscopy old blood was visualized in the rectum, the sigmoid, and the left and transverse colon. Additional bright red blood was observed at the level of the right colon.

This video describes the technique for repair of central ventral defects by endoscopic subcutaneous component separation, suture closure of the central ventral defects using V-Loc™ suture and reinforcement of the reconstruction with an underlay composite mesh. Advantages of this approach are the preservation of abdominal wall dynamics with a low recurrence rate and fewer complications usually observed in other complex abdominal reconstructions such as seromas, hematomas, infection, pain, delayed recovery, and undesirable cosmetic results. The video shows the endoscopic subcutaneous component separation technique in detail as well as the identification and closure of the central ventral defect and the underlay placement of a composite mesh. CT-scan images of abdominal wall reconstruction at three months postoperatively are presented. In our first 6 cases, early clinical and CT-scan results were encouraging.

Foreign body ingestion occurs more commonly in children with a peak incidence in the age group of 6 months to 3 years. In adults, it occurs mostly in edentulous patients, prisoners and psychiatric patients.
80-90% of the foreign bodies that reach the gastrointestinal tract will pass spontaneously; 10-20 % will have to be removed endoscopically and unfortunately, 1% requires surgery.
The decision and timing of endoscopic intervention depends on the patient’s age, clinical condition, size, shape and classification of ingested material, anatomical location, risk of aspiration and/or perforation and technical abilities of the endoscopist.
Accidentally swallowed dentures can lead to severe complications in the gastrointestinal tract, such as perforation that needs surgical intervention.
In this video, we present the endoscopic removal of a fixed four-dental prosthesis accidentally swallowed and blocked in the prepyloric zone.

Reference:
Management of foreign bodies of the upper gastrointestinal tract: update. William A. Webb Gastrointestinal Endoscopy, Vol 41, No.1, 1995.

Periampullary duodenal diverticula are observed in 10-20% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and could well increase ampulla cannulation failure risk, as well as potential complications related to endoscopic sphincterotomy.
Here we report two successful cases of large intradiverticular endoscopic biliary sphincterotomy in the treatment of two different kinds of benign biliary pathologies. The first case was that of a woman with multiple large stones in the common bile duct (CBD). The second case was one of a male patient with cholestasis due to a compression of the distal common bile duct caused by a diverticulum – this condition being known as Lemmel’s syndrome.

In this authoritative lecture, Dr. Pech outlines the endoscopic treatment of foregut neoplasia. He summarizes risk factors for lymph node metastasis in relation to squamous cell carcinoma (SCC). He compares EMR with ESD, and looks into the postoperative management and indications of endoscopic management for Barrett’s cancer. He briefly describes the indications of endoscopic treatment according to the 2016 Japanese guidelines. He also summarizes LN risks and ESD criteria in early gastric cancer.

A 48-year-old man was addressed for endoscopic evaluation of chronic pain of the left lower quadrant. Gastroscopy was unrevealing. However, colonoscopy disclosed a villous-like pedunculated polyp of the sigmoid colon, 2.5cm in diameter, with fresh blood distally to it. Due to its size and to the high risk of bleeding, we decided to remove it by means of the endoloop technique.

Duodenal diverticula are found in approximately 10-20% of patients undergoing Endoscopic Retrograde Cholangio-Pancreatography (ERCP).
Usually, these diverticula lie within 2cm of the major duodenal papilla and are called juxtapapillary diverticula. They are mostly acquired and their incidence increases with age.
Juxtapapillary diverticula have often been associated with mechanical compression and they are also involved in Oddi’s sphincter dysfunction. The presence of juxtapapillary diverticula is known to influence the outcome of ERCP procedure by making it more difficult and causing some complications like bleeding. Various techniques have been advised for a more successful ERCP outcome
In this video, four cases of duodenal diverticula are presented to provide tips and tricks for the successful cannulation of the CBD and management of periampullary bleeding in case they occur.

The transanal approach for early stage rectal cancer has been well established but some complications can sometimes occur. In this lecture, Dr. Whiteford demonstrates the complications related to this technique.