nysge - new york society for gastrointestinal endoscopy - case … course/nysge 2015... · 2016. 3....

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


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



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.



CASE 2-B.V

Path: Tubular Adenoma Plan: EMR of the colon polyp



Case 3-M.K

55 y.o M with no significant PMHx c/o regurgitating food at night.

EGD/Esophagram: Zenker’s diverticulum



Case 3-M.K

Plan: Endoscopic Cricopharyngeal myotomy



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 overlying Barrett’s esophagus.

• Biopsies of Barrett’s esophagus revealed foci of low grade dysplasia.



Case 4- T.M



Case 4- T.M

• Plan: Variceal banding. Examine the Barrett’ s mucosa using Nine-point and obtain targeted biopsies.



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


CASE 5-A.H

Post op she was noted to have a recto-vaginal fistula.

Plan: Attempt endoscopic closure of the fistula.



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.



Case 6-DG

Colonoscopy: 18mm mid ascending colon mass

Pathology: Invasive moderately differentiated adenocarcinoma

CT abd/pelvis : No evidence of metastatic disease



Case 6-DG

PLAN: Endoscopic submucosal dissection of ascending colon lesion.



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



Case 7-JG



Case 7-JG ERCP:



Case 7-JG

• Plan: EUS guided biliary drainage



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 of distribution.



Case 8 - B.L

• Plan: EMR of the colon polyp



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.


36th Annual New York Course • December 19-22, 2012 39th annual New York Course December 2015

MRCP images on pancreatic divisum


Case 9- R. J. Plan:

ERCP with stent placement



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 of a 12.5mm tablet

Manometry:

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



Case 10-JC

Prior treatments with botox and ballon dilatation with only transient relief.

Plan: POEM



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.



• 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


• 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


Case 12 - M.M


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.


36th Annual New York Course • December 19-22, 2012 39th annual New York Course December 2015


Case 13 - J. A.

Plan: EUS guided cyst gastrostomy



• 55 yr old F with h/o HTN, newly diagnosed renal cell cancer had a CT scan showing mass invading porta hepatis causing biliary obstruction 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.


Case 14 – M.S.


• The biliary obstruction was treated with stent placement using EUS-guided biliary drainage.

• PLAN: EUS guided gastro jejunostomy


Case 14 – M.S.


• 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.


Case 15 - J.H


• 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


Case 15 - J.H.


• Plan: EMR of the lesion


Case 15 - J.H.


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



Case 16 - S. X.



Case 16 - S. X.

Plan: ERCP with lithotripsy



• 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.


Case 17 - C.G.

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

Case 17 - C.G


• ERCP (12/3/15)- Stricture at the hepatic duct bifurcation. Spyglass exam was performed-smooth narrowing at the bifurcation, no mass or 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.


Case 17 - C.G

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

nysge - new york society for gastrointestinal endoscopy - case … course/nysge 2015... · 2016. 3....

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