Interventional EUS Using a Flexible 19-Gauge Needle: An International Multicenter Experience in 162 Patients.

BACKGROUND AND AIMS: To facilitate access for interventional EUS, flexible (nitinol) 19-G needles have been introduced to permit needle puncture even when the echoendoscope is in an angulated position, such as in the second part of the duodenum. The aims of the study were to evaluate the performance of a flexible 19-G needle during interventional EUS procedures and compare outcomes when the echoendoscope was in the straight versus angulated position. METHODS: A retrospective review was undertaken of 162 consecutive patients that underwent a variety of interventional EUS procedures with a flexible 19-G needle across five centers. Patients were subdivided into categories (straight or angulated) depending on the echoendoscope position used for obtaining access to the area of interest (Fig. 1). Fig. 1 Flexible 19-G needle design. a The needle is able to exit the sheath despite the rotated position. b The needle beveled needle tip RESULTS: In the entire cohort, needle-specific technical success was achieved in 93.2 %, procedural success in 85.2 %, and overall clinical success in 76.5 % of cases at a mean follow-up of 3.1 months. Needle-specific technical success was similar between the straight and angulated cohorts (94.0 vs. 91.2 %, p = 0.74). Procedural success (86.7 vs. 77.2 %, p = 0.05), and rate of clinical success was similar between the cohorts (83.3 vs. 86.4 %, p = 0.79), respectively. Overall adverse events were noted in 14.2 % of patients with no difference between the straight and angulated cohorts (p = 0.48). CONCLUSIONS: This study demonstrates equivalent technical success, clinical success and safety of using a flexible 19-G needle in straight and angulated endoscope positions for interventional EUS. Therefore, a flexible needle may be considered where an angulated echoendoscope position is encountered.

Uvular Necrosis Following Esophagogastroduodenoscopy: A Case Report.

BACKGROUND Uvular necrosis is an uncommon complication of esophagogastroduodenoscopy. It usually presents with sore throat, fever, foreign-body sensation, and odynophagia following esophagogastroduodenoscopy. It occurs due to impairment of local circulation, which is caused by impingement of the uvula between the endoscope and the hard palate. It may also arise from excessive suctioning of the area surrounding the uvula. We present a case of uvular necrosis following esophagogastroduodenoscopy and describe current strategies to prevent this rare complication. CASE REPORT A 19-year-old man presented with a 4-day history of odynophagia, severe sore throat, and foreign-body sensation that started within 24 h after esophagogastroduodenoscopy. Uvular necrosis was observed on physical examination. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs and antibiotics, and his symptoms resolved completely. CONCLUSIONS We believe that this is the sixth reported case of uvular necrosis following an uncomplicated diagnostic esophagogastroduodenoscopy in a young patient. Esophagogastroduodenoscopy is a routine procedure performed by gastroenterologists. Uvular necrosis can occur as a rare complication of esophagogastroduodenoscopy; therefore, it is important to monitor patients for odynophagia and abnormal foreign-body sensation following the procedure for at least 72 h. Uvular necrosis should be suspected if odynophagia persists after this period despite adequate treatment with conventional analgesics. Prompt diagnosis and management can relieve the patient's symptoms, given that uvular necrosis is a self-limiting complication with a good prognosis.

Gastric Duplication Cyst With Elevated Amylase: An Unusual Presentation Mimicking Pancreatic Cystic Neoplasm.

Enteric duplication cysts (EDCs) are benign congenital anomalies that are found incidentally in adults. Gastric duplication cysts (GDCs) are the least common subtype of EDC, but when located near the pancreas, may resemble other neoplastic conditions. We report a case of GDC adjacent to the pancreas with high cystic fluid amylase and carcinoembryonic antigen (CEA) and 3 different epithelia (respiratory, gastric, and intestinal), all diagnosed via endoscopic ultrasound with fine-needle aspiration.

Role of self-expandable metal stents in acute variceal bleeding.

Acute variceal bleeding continues to be associated with significant mortality. Current standard of care combines hemodynamic stabilization, antibiotic prophylaxis, pharmacological agents, and endoscopic treatment. Rescue therapies using balloon tamponade or transjugular intrahepatic portosystemic shunt are implemented when first-line therapy fails. Rescue therapies have many limitations and are contraindicated in some cases. Placement of fully covered self-expandable metallic stent is a promising therapeutic technique that can be used to control bleeding in cases of refractory esophageal bleeding as an alternative to balloon tamponade. These stents can be left in place for as long as two weeks, allowing for improvement in liver function and institution of a more definitive treatment.

Pulmonary embolism following 2-octyl-cyanoacrylate/lipiodol injection for obliteration of gastric varices: an imaging perspective.

Bleeding from esophageal and gastric varices remains a significant cause of morbidity and mortality for patients with liver cirrhosis. Currently, therapeutic strategies for gastric variceal bleeding include transjugular intrahepatic portosystemic shunt, cyanoacrylate sclerotherapy and hepatic transplantation. Though relatively safe and efficacious, endoscopic sclerotherapy using cyanoacrylate has known complications including infection, bleeding, and distal embolization. This case report describes a patient who became febrile and tachycardic following sclerotherapy and subsequently had an abnormal chest radiograph that prompted further evaluation for pulmonary embolization of the sclerosant. The focuses of this report are the computed tomographic and radiographic findings associated with 2-octyl-cyanoacrylate/lipiodol pulmonary embolization.