Case 1- B.N 66 yr old F with PMHx of breast cancer s/ p mastectomy, - - PowerPoint PPT Presentation

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Case 1- B.N 66 yr old F with PMHx of breast cancer s/ p mastectomy, - - PowerPoint PPT Presentation

Jun 15, 2023 172 likes •627 views

Case 1- B.N 66 yr old F with PMHx of breast cancer s/ p mastectomy, HTN, DM presented with dysphagia to solids and liquids. Reports retching to clear esophagus. 39 th annual New York Course December 2015 36th Annual New York Course December

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36th Annual New York Course • December 19-22, 2012

Case 1- B.N

66 yr old F with PMHx of breast cancer s/ p mastectomy, HTN, DM presented with dysphagia to solids and liquids. Reports retching to clear esophagus.

39th annual New York Course December 2015

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SLIDE 2

36th Annual New York Course • December 19-22, 2012

Case 1- B.N

EGD: Stricture in the distal esophagus, endoscope not able to pass the stricture. Plan: EGD with dilation of the distal esophageal stricture

39th annual New York Course December 2015

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SLIDE 3

36th Annual New York Course • December 19-22, 2012

CASE 2-B.V

85 year old male with HTN, DM, s/p pacemaker and CAD had a colonoscopy showing one large polyp in the proximal transverse colon close to the hepatic

  • flexure. It was tattooed.

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

CASE 2-B.V

Path: Tubular Adenoma Plan: EMR of the colon polyp

39th annual New York Course December 2015

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SLIDE 5

36th Annual New York Course • December 19-22, 2012

Case 3-M.K

55 y.o M with no significant PMHx c/o regurgitating food at night. EGD/Esophagram: Zenker’s diverticulum

39th annual New York Course December 2015

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SLIDE 6

36th Annual New York Course • December 19-22, 2012

Case 3-M.K

Plan: Endoscopic Cricopharyngeal myotomy

39th annual New York Course December 2015

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SLIDE 7

36th Annual New York Course • December 19-22, 2012

Case 4- T.M

  • 68 yr old male with PMHx of Alcoholic

cirrhosis and HTN was noted to have gastro-esophageal varices (GOV-2) with

  • verlying Barrett’s esophagus.
  • Biopsies of Barrett’s esophagus revealed

foci of low grade dysplasia.

39th annual New York Course December 2015

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SLIDE 8

36th Annual New York Course • December 19-22, 2012

Case 4- T.M

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 4- T.M

  • Plan: Variceal banding. Examine the

Barrett’ s mucosa using Nine-point and

  • btain targeted biopsies.

39th annual New York Course December 2015

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SLIDE 10

36th Annual New York Course • December 19-22, 2012

CASE 5-A.H

70 year old F with h/o uterine cancer s/p surgery and radiation therapy presented with recto-sigmoid adenocarcinoma. She underwent lower anterior resection 6 weeks ago for the recto-sigmoid cancer.

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

CASE 5-A.H

Post op she was noted to have a recto- vaginal fistula. Plan: Attempt endoscopic closure of the fistula.

39th annual New York Course December 2015

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SLIDE 12

36th Annual New York Course • December 19-22, 2012

Case 6-DG

83 y.o M with significant cardiac history/ AICD, personal history of colon polyps underwent surveillance colonoscopy. Pt’s father had CRC at age of 54.

39th annual New York Course December 2015

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SLIDE 13

36th Annual New York Course • December 19-22, 2012

Case 6-DG

Colonoscopy: 18mm mid ascending colon mass Pathology: Invasive moderately differentiated adenocarcinoma CT abd/pelvis : No evidence of metastatic disease

39th annual New York Course December 2015

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SLIDE 14

36th Annual New York Course • December 19-22, 2012

Case 6-DG

PLAN: Endoscopic submucosal dissection of ascending colon lesion.

39th annual New York Course December 2015

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SLIDE 15

36th Annual New York Course • December 19-22, 2012

Case 7- JG

70 y.o M with Stage IV colon Ca (Dx 2009; mets to liver and lung) presents with pruritus, increasing abdominal pain, and weight loss. Labs: Alt: 83 Ast: 76 Alk phos: 1345 Total bilirubin: 29

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 7-JG

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 7-JG

ERCP:

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 7-JG

  • Plan:

EUS guided biliary drainage

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 8 - B.L

  • 79 yr old M with was found to have a sessile

3cm polyp in the proximal ascending colon during a surveillance colonoscopy.

  • Biopsy: Tubular adenoma with focal dysplastic

non-infiltrative glands with an unusual pattern

  • f distribution.

39th annual New York Course December 2015

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SLIDE 20

36th Annual New York Course • December 19-22, 2012

Case 8 - B.L

  • Plan: EMR of the colon polyp

39th annual New York Course December 2015

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SLIDE 21

36th Annual New York Course • December 19-22, 2012

Case 9- R. J.

  • 52 yr old female with a PMHx of two episodes of pancreatitis in

January of 2014 and August 2015. Lipase on both admissions was >12,000.

  • Imaging and laboratory studies on both admissions did not reveal

a clear etiology for pancreatitis; other than gall bladder sludge.

  • MRCP noted pancreatic divisum without evidence of pancreatic

mass.

39th annual New York Course December 2015

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SLIDE 22

36th Annual New York Course • December 19-22, 2012

39th annual New York Course December 2015

MRCP images on pancreatic divisum

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SLIDE 23

36th Annual New York Course • December 19-22, 2012

Case 9- R. J.

Plan: ERCP with stent placement

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 10-JC

72 y.o F complains of delayed passage of food bolus and progressive weight loss. EGD: Mildly dilated esophagus Barium esophagram: Dilated esophagus to 3.9cm with complete obstruction

  • f a 12.5mm tablet

Manometry: Incomplete LES relaxation and absent peristalsis. Consistent with Type I achalasia.

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 10-JC

Prior treatments with botox and ballon dilatation with only transient relief. Plan: POEM

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 11 - L.Y

60 year old female with ampullary adenoma that was discovered after an MRCP showed a soft tissue filling defect in the distal CBD with dilation of the CBD and PD. Plan: Ampullectomy.

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

  • 55 year old female with PMHx of depression,

and lupus p/w heartburn and regurgitation, worse with late night meals.

  • Frequent coughing and constantly needing to

clear her throat.

  • No response to PPI.

New York Society for Gastrointestinal Endoscopy

Case 12 - M.M

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SLIDE 28

36th Annual New York Course • December 19-22, 2012

  • High resolution manometry showed

aperistalsis and normal LES relaxation. Bravo pH study was positive.

  • She does not want to have antireflux surgery.
  • Plan: Endoscopic Fundoplication using

Esophyx

New York Society for Gastrointestinal Endoscopy

Case 12 - M.M

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SLIDE 29

36th Annual New York Course • December 19-22, 2012

Case 13 - J. A.

  • 57 yr old male with a PMHx of chronic

pancreatitis, alcoholic cirrhosis presented to OSH presented with abdominal pain.

  • Was found to have a large pseudocyst.

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

Case 13 - J. A.

Plan: EUS guided cyst gastrostomy

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

  • 55 yr old F with h/o HTN, newly diagnosed

renal cell cancer had a CT scan showing mass invading porta hepatis causing biliary

  • bstruction with biliary tree, as well as PD

dilation.

  • Patient underwent EUS/ERCP where a biliary

tract obstruction secondary to a tumor was found involving the middle third of the main duct as well.

New York Society for Gastrointestinal Endoscopy

Case 14 – M.S.

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36th Annual New York Course • December 19-22, 2012

  • The biliary obstruction was treated with stent

placement using EUS-guided biliary drainage.

  • PLAN: EUS guided gastro jejunostomy

New York Society for Gastrointestinal Endoscopy

Case 14 – M.S.

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36th Annual New York Course • December 19-22, 2012

  • 76 yr old M with PMHx HTN, carotid artery

stenosis, GERD and H. pylori infection s/p treatment was referred to our clinic for a lesion in the gastric cardia with high grade dysplasia.

New York Society for Gastrointestinal Endoscopy

Case 15 - J.H

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36th Annual New York Course • December 19-22, 2012

  • Previous history
  • 2009: ESD of the 3x2cm gastric cardia

lesion- High grade dysplasia

  • 2012: EMR of the gastric cardia lesion- High

grade dysplasia

  • 2015: Cardia Nodule. Biopsy- High-grade

dysplasia

New York Society for Gastrointestinal Endoscopy

Case 15 - J.H.

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SLIDE 36

36th Annual New York Course • December 19-22, 2012

  • Plan: EMR of the lesion

New York Society for Gastrointestinal Endoscopy

Case 15 - J.H.

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SLIDE 37

36th Annual New York Course • December 19-22, 2012

Case 16 - S. X.

74 yr old female with a PMHx of recurrent choledocholithiasis p/w RUQ abdominal pain, fever. Labs revealed elevated WBC and cholestatic liver injury pattern. ERCP - large common bile duct stone. 7fr 10cm double Pigtail stent placed

39th annual New York Course December 2015

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SLIDE 38

36th Annual New York Course • December 19-22, 2012

Case 16 - S. X.

39th annual New York Course December 2015

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SLIDE 39

36th Annual New York Course • December 19-22, 2012

Case 16 - S. X.

Plan: ERCP with lithotripsy

39th annual New York Course December 2015

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36th Annual New York Course • December 19-22, 2012

  • 50 yr old M with h/o UC and PSC, recurrent

cholangitis and CBD strictures s/p multiple dilations in the past presented with new dominant stricture and elevated CA 19.9 (540).

  • MRCP: Dominant stricture at the confluence of

the Right and Left hepatic ducts. No discrete mass.

New York Society for Gastrointestinal Endoscopy

Case 17 - C.G.

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SLIDE 41

36th Annual New York Course • December 19-22, 2012 New York Society for Gastrointestinal Endoscopy

Case 17 - C.G

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36th Annual New York Course • December 19-22, 2012

  • ERCP (12/3/15)- Stricture at the hepatic duct
  • bifurcation. Spyglass exam was performed-

smooth narrowing at the bifurcation, no mass

  • r abnormal vessels. A 7F x 7 cm plastic stent

was placed.

  • Both biopsy and FISH analysis were negative.
  • Plan: Re-evaluate the Stricture with Spyglass.

New York Society for Gastrointestinal Endoscopy

Case 17 - C.G

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36th Annual New York Course • December 19-22, 2012 New York Society for Gastrointestinal Endoscopy

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36th Annual New York Course • December 19-22, 2012 New York Society for Gastrointestinal Endoscopy