VideoGIE
events in choledochoduodenostomy that were managed by performing direct retrograde cholangioscopy (DRC). We used standard ultraslim video endoscopes with an outer diameter of approximately 6 mm (GIF-XP 180N, GIF N180; Olympus Europe, Hamburg, Germany) together with insufflation of carbon dioxide in these cases. (1) Risk of malignancy in CD. Late development of cancer in patients with choledochoenteral anastomosis occurs in as many as 5% to 8% of cases. Cancer may be even more frequent in CD (w7%-8%) than in choledochojejunal anastomosis (w5%) at long-term follow-up. Concomitant disease such as biliary cystic disease or Caroli disease could be an additional risk factor for malignancy. We demonstrate the case of a 45-year-old female patient with Todani type 5 biliary cysts (Caroli disease) and adenocarcinoma at the site of the CD. DRC visualizes the short extent of the tumor that is strictly restricted to the anastomosis and biliary cysts that are free of malignancy. (2) Extension of adenoma in the common bile duct after CD for adenoma of the ampulla of Vater. After surgical transduodenal CD for adenoma of the ampulla of Vater, a 50-year-old woman presented with recurrent symptoms, ie, colicky pain and icterus. At DRC, stones were detected
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
in the common bile duct and adenomatous tissue proximal to the site of the CD; this was confirmed by histopathology of a DRC-guided biopsy. A pylorus-preserving pancreaticoduodenectomy was later performed, thereby resecting the part of the bile duct with the adenoma. (3) The sump syndrome in CD. Cholangitis may occur in choledochoenteral anastomosis in 10% to 15% of cases during long-term follow-up and is mainly the result of sump syndrome or anastomotic stricture formation. We present the case of recurring cholangitis for sump syndrome in CD and endoscopic management by use of DRC. All 3 scenarios highlight the value of DRC in patients with adverse events from CD. It is crucial for the endoscopist to be aware of the postoperatively altered anatomy in CD and to know about these adverse events (Fig.1; Video 1, available online at www.giejournal.org). DISCLOSURE All authors disclosed no financial relationships relevant to this article. Jörg G. Albert, MD,1 Andrea Tal, MD,1 Wolf O. Bechstein, MD,2 Jörg Trojan, MD,1 Andreas Schnitzbauer, MD,2 Medizinische Klinik I (1), Klinik für Allgemein- und Viszeralchirurgie (2), Universitätsklinikum der Johann-Wolfgang-Goethe-Universität, Klinikum der J. W. Goethe-Universität, Frankfurt, Germany.
http://dx.doi.org/10.1016/j.gie.2014.05.324
Adult ileocolic intussusception: endoscopic treatment A 21-year-old previously healthy woman was admitted, reporting periumbilical abdominal pain that started 1 day before. An abdominal CT scan showed a typical targetshape mass in the right abdomen suggestive of intussusception (Fig. 1). The patient was hospitalized, and a colonoscopy with anterograde cleaning was performed.
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
When the colonoscope reached the cecum, it was noticed that 15 cm of the terminal ileum was invaginated through the ileocecal valve without any other findings. Despite edema and erythema, intubation of the ileum was possible. At the cecum, a hyperinsuflation was performed, and intubating the ileum repeatedly resulted in the reduction of the intussusception (Video 1, available online at www.giejournal.org). A CT scan performed immediately after colonoscopy showed complete resolution of obstruction (Fig. 2). The patient was discharged asymptomatic on the following day. During the control colonoscopy performed 1 month later, the colon and terminal ileum were endoscopically normal. The patient remains asymptomatic. Of all the conservative treatment options available for ileocolic intussusception, endoscopic treatment was used successfully in this case.
464 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 2 : 2015
www.giejournal.org
VideoGIE
Figure 1. Abdominal CT scan at admission showed a target-shape mass.
DISCLOSURE All authors disclosed no financial relationships relevant to this article. Marcelo Averbach, MD, PhD,1 Rodrigo de 1,3 Rezende Zago, MD, Pedro Popoutchi, MD,1,3 Celso Augusto Milani Cardoso Filho, MD,2 Oswaldo Wiliam
Figure 2. CT scan performed after colonoscopy showed complete resolution of obstruction.
Marques Júnior, MD,1 Hospital Sírio-Libanês (1), A. C. Camargo Cancer Center (2), Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil (3).
http://dx.doi.org/10.1016/j.gie.2014.04.045
Successful management of distal intestinal obstruction syndrome with a jet irrigation flushing device during colonoscopy Distal intestinal obstruction syndrome (DIOS) is a common intestinal adverse event in adults with cystic fibrosis, usually presenting with crescendo symptoms
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. www.giejournal.org
of abdominal pain, distension, and vomiting, and can lead to complete small-bowel obstruction. We report a case of DIOS refractory to usual medical therapy but successfully managed with use of the JetPrep irrigation catheter (JetPrep Ltd, Herzliya, Israel) during colonoscopy. A 20-year-old man with known cystic fibrosis presented with a 3-day history of severe abdominal pain, distension, and vomiting caused by DIOS. His abdominal radiograph (Fig. 1) showed grossly distended, contrast-filled loops of small bowel. His symptoms did not resolve despite the use of conventional treatment, including intravenous hydration, N-acetylcysteine, Gastrografin (Bayer PLC, Volume 81, No. 2 : 2015 GASTROINTESTINAL ENDOSCOPY 465
events in choledochoduodenostomy that were managed by performing direct retrograde cholangioscopy (DRC). We used standard ultraslim video endoscopes with an outer diameter of approximately 6 mm (GIF-XP 180N, GIF N180; Olympus Europe, Hamburg, Germany) together with insufflation of carbon dioxide in these cases. (1) Risk of malignancy in CD. Late development of cancer in patients with choledochoenteral anastomosis occurs in as many as 5% to 8% of cases. Cancer may be even more frequent in CD (w7%-8%) than in choledochojejunal anastomosis (w5%) at long-term follow-up. Concomitant disease such as biliary cystic disease or Caroli disease could be an additional risk factor for malignancy. We demonstrate the case of a 45-year-old female patient with Todani type 5 biliary cysts (Caroli disease) and adenocarcinoma at the site of the CD. DRC visualizes the short extent of the tumor that is strictly restricted to the anastomosis and biliary cysts that are free of malignancy. (2) Extension of adenoma in the common bile duct after CD for adenoma of the ampulla of Vater. After surgical transduodenal CD for adenoma of the ampulla of Vater, a 50-year-old woman presented with recurrent symptoms, ie, colicky pain and icterus. At DRC, stones were detected
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
in the common bile duct and adenomatous tissue proximal to the site of the CD; this was confirmed by histopathology of a DRC-guided biopsy. A pylorus-preserving pancreaticoduodenectomy was later performed, thereby resecting the part of the bile duct with the adenoma. (3) The sump syndrome in CD. Cholangitis may occur in choledochoenteral anastomosis in 10% to 15% of cases during long-term follow-up and is mainly the result of sump syndrome or anastomotic stricture formation. We present the case of recurring cholangitis for sump syndrome in CD and endoscopic management by use of DRC. All 3 scenarios highlight the value of DRC in patients with adverse events from CD. It is crucial for the endoscopist to be aware of the postoperatively altered anatomy in CD and to know about these adverse events (Fig.1; Video 1, available online at www.giejournal.org). DISCLOSURE All authors disclosed no financial relationships relevant to this article. Jörg G. Albert, MD,1 Andrea Tal, MD,1 Wolf O. Bechstein, MD,2 Jörg Trojan, MD,1 Andreas Schnitzbauer, MD,2 Medizinische Klinik I (1), Klinik für Allgemein- und Viszeralchirurgie (2), Universitätsklinikum der Johann-Wolfgang-Goethe-Universität, Klinikum der J. W. Goethe-Universität, Frankfurt, Germany.
http://dx.doi.org/10.1016/j.gie.2014.05.324
Adult ileocolic intussusception: endoscopic treatment A 21-year-old previously healthy woman was admitted, reporting periumbilical abdominal pain that started 1 day before. An abdominal CT scan showed a typical targetshape mass in the right abdomen suggestive of intussusception (Fig. 1). The patient was hospitalized, and a colonoscopy with anterograde cleaning was performed.
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
When the colonoscope reached the cecum, it was noticed that 15 cm of the terminal ileum was invaginated through the ileocecal valve without any other findings. Despite edema and erythema, intubation of the ileum was possible. At the cecum, a hyperinsuflation was performed, and intubating the ileum repeatedly resulted in the reduction of the intussusception (Video 1, available online at www.giejournal.org). A CT scan performed immediately after colonoscopy showed complete resolution of obstruction (Fig. 2). The patient was discharged asymptomatic on the following day. During the control colonoscopy performed 1 month later, the colon and terminal ileum were endoscopically normal. The patient remains asymptomatic. Of all the conservative treatment options available for ileocolic intussusception, endoscopic treatment was used successfully in this case.
464 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 2 : 2015
www.giejournal.org
VideoGIE
Figure 1. Abdominal CT scan at admission showed a target-shape mass.
DISCLOSURE All authors disclosed no financial relationships relevant to this article. Marcelo Averbach, MD, PhD,1 Rodrigo de 1,3 Rezende Zago, MD, Pedro Popoutchi, MD,1,3 Celso Augusto Milani Cardoso Filho, MD,2 Oswaldo Wiliam
Figure 2. CT scan performed after colonoscopy showed complete resolution of obstruction.
Marques Júnior, MD,1 Hospital Sírio-Libanês (1), A. C. Camargo Cancer Center (2), Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil (3).
http://dx.doi.org/10.1016/j.gie.2014.04.045
Successful management of distal intestinal obstruction syndrome with a jet irrigation flushing device during colonoscopy Distal intestinal obstruction syndrome (DIOS) is a common intestinal adverse event in adults with cystic fibrosis, usually presenting with crescendo symptoms
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. www.giejournal.org
of abdominal pain, distension, and vomiting, and can lead to complete small-bowel obstruction. We report a case of DIOS refractory to usual medical therapy but successfully managed with use of the JetPrep irrigation catheter (JetPrep Ltd, Herzliya, Israel) during colonoscopy. A 20-year-old man with known cystic fibrosis presented with a 3-day history of severe abdominal pain, distension, and vomiting caused by DIOS. His abdominal radiograph (Fig. 1) showed grossly distended, contrast-filled loops of small bowel. His symptoms did not resolve despite the use of conventional treatment, including intravenous hydration, N-acetylcysteine, Gastrografin (Bayer PLC, Volume 81, No. 2 : 2015 GASTROINTESTINAL ENDOSCOPY 465
