Tag Archives: Endoscopic

General Surgery, Print Release

PUBLISHED: Endoscopic Evaluation of a Twisted Gastric Sleeve Causing Severe Reflux and Epigastric Pain

Endoscopic Evaluation of a Twisted Gastric Sleeve Causing Severe Reflux and Epigastric Pain
Saamia Shaikh, DO, JD; Eric M. Pauli, MD, FACS, FASGE, FEBSAWS (Hon.)
Penn State Health Milton S. Hershey Medical Center

Upper endoscopy is an essential diagnostic and therapeutic tool in the evaluation of patients with gastrointestinal symptoms. Particularly in bariatric surgery patients, endoscopy is a valuable tool in the preoperative, intraoperative, and postoperative period. It is an increasingly important skill for surgeons managing surgical complications. This article presents a 48-year-old female who presented one year after undergoing a robotic-assisted sleeve gastrectomy and cholecystectomy with persistent epigastric pain and severe reflux symptoms. She had multiple emergency department visits following surgery, and prior computed tomography imaging was initially interpreted as normal without evidence of leak or obstruction, but on further review demonstrated a twisted configuration of the gastric sleeve.

Upper endoscopy was performed using an Olympus GIF-HQ190 gastroscope, with the scope advanced under direct visualization through the esophagus, stomach, and into the second portion of the duodenum. Endoscopy revealed a widened hiatus consistent with a small hiatal hernia, as well as moderate luminal stenosis near the incisura with a spiral configuration of the staple line, consistent with a gastric sleeve twist. Proximal gastric dilation and bile reflux were also appreciated. This case highlights the importance of surgeon review of imaging studies and surgeon performed endoscopy in evaluating complex postoperative anatomy and underscores its role as a critical skill for surgeons involved in the long-term care of surgical patients.

General Surgery, Print Release

Laparoscopic-Assisted Takedown of a Gastrocutaneous Fistula

Laparoscopic-Assisted Takedown of a Gastrocutaneous Fistula
Victoria J. Grille, MD1; Eric M. Pauli, MD, FACS, FASGE2
1Jersey Shore University Medical Center
2Penn State Milton S. Hershey Medical Center

A gastrocutaneous fistula is an abnormal connection between the stomach and skin, most commonly occurring after removal of a gastrostomy feeding tube. This video demonstrates the surgical technique of laparoscopic takedown of a gastrocutaneous fistula, performed in conjunction with upper endoscopy. The patient is a pediatric patient with a history of gastrostomy tube placement and Nissen fundoplication for reflux during infancy. Despite removal of the tube, the fistula persisted. Prior endoscopic interventions, including over-the-scope clip placement, were unsuccessful. Due to ongoing drainage and patient preference for definitive closure, surgical intervention was pursued.

General Surgery, Print Release

PUBLISHED: Peroral Endoscopic Myotomy (POEM) for Achalasia

Peroral Endoscopic Myotomy (POEM) for Achalasia

Daniel Hashimoto; Ozanan R Meireles, MD; David Rattner, MD
Massachusetts General Hospital

Impaired transit of food and liquid from the esophagus to the stomach results in symptoms of dysphagia, regurgitation, retrosternal fullness/pain, and weight loss. Symptoms can be managed with a range of medical or procedural therapy. However, the best results are obtained from surgical management with myotomy. Here, Drs. Rattner, Meireles, and Hashimoto at MGH perform and demonstrate a peroral endoscopic myotomy (POEM), which emerged as a less invasive manner through which to perform a myotomy and provides relief of dysphagia comparable to laparoscopic Heller myotomy – the current standard of surgical therapy for achalasia.

Otolaryngology, Print Release

PUBLISHED: Zenker’s Diverticulum: Endoscopic Staple-Assisted Diverticulotomy

Zenker’s Diverticulum: Endoscopic Staple-Assisted Diverticulotomy

Seth M. Cohen, MD, MPH1; David Straka, MD1; Blaine D. Smith, MD1; Douglas O’Connell, MSc2; C. Scott Brown, MD1

1Duke University Medical Center
2College of Osteopathic Medicine, Touro University California

In this case, a patient with a symptomatic Zenker’s diverticulum is treated with an endoscopic staple-assisted diverticulotomy. The clinical presentation, diagnostic criteria, surgical procedure, and postoperative care are highlighted.

Otolaryngology, Preprint Release

PREPRINT RELEASE: Functional Endoscopic Sinus Surgery (Cadaveric): Maxillary, Ethmoid, Sphenoid

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Functional Endoscopic Sinus Surgery (Cadaveric): Maxillary, Ethmoid, Sphenoid
Duke University School of Medicine
David W Jang, MD
Assistant Professor of Surgery
C. Scott Brown, MD
Resident Physician

Dr. Jang instructs a cadaver lab to educate the residents at Duke University on the steps and technical aspects of various endoscopic sinus surgery procedures.