Single Incision Experience At San Diego: The Evolution of Clear Imaging
Objective: Classic laparoscopic surgery is based on the ability to triangulate instrumentation to have good exposure and working space. This is done with multiple trans-abdominal ports. Decreasing the number of ports may be beneficial in decreasing pain. In addition elimination of port sites eliminates the risk of herniation at those sites and provides a definite… Continue Reading
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Endoscopic and Manometric Characteristics of the Gastroesophageal Valve in Lateral Decubitus and Upright Positions in Clinically Normal Patients
Background: The relationship between body position and the gastroesophageal junction (GEJ) has been subject to intense interest in its role in gastroesophageal reflux disease (GERD). Few studies have looked at the position related changes of the gastroesophageal valve (GEV) in asymptomatic individuals.Purpose: To define the normal physiology of the GEJ in left lateral decubitus (LLD)… Continue Reading
Endoscopic Ultrasound-guided Gastrostomy After Roux-en-Y Gastric Bypass: A Novel Approach
Objective: Gastrostomy tube (GT) placement after Roux-en-Y gastric bypass can be challenging. Novel, minimally invasive approaches are needed to access the gastric remnant in these patients. Our objective is to present an innovative method of endoscopic ultrasound (EUS)-guided GT placement.Procedure Description: A 55 year-old morbidly obese female underwent reoperative, open retrocolic Roux-en-Y gastric bypass, and… Continue Reading
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Esophageal Dilatation for Corrosive Stricture of the Esophagus
Less was known regarding outcome of dilatation in corrosive stricture of the esophagus. The aim of this study was to report the treatment outcome of dilatation for corrosive esophageal stricture.Methods: Medical records of twenty-three patients with corrosive esophageal stricture who underwent esophagal dilatations were reviewed. All dilatations were performed under general anesthesia using Savary-Gillard dilator… Continue Reading
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Prospective Monitoring of Surgical Trainee Endoscopy Volumes
Introduction: Despite a recent increase in endoscopic surgery requirements for graduate surgical trainees by the Residency Review Committee for Surgery (RRC-S), there is still a question of competence: is the endoscopic volume achieved by surgical trainees sufficient for the procedural competence needed by practicing surgeons in academic centers and community hospitals? Prospective monitoring of trainee… Continue Reading
Accessing the Gastric Remnant After Roux-en-Y Gastric Bypass
INTRODUCTION: A minimally invasive method for accessing the gastric remnant to intervene on the biliary and pancreatic system after Roux-en-Y gastric bypass (RYGB) has not been well described. This is a retrospective review describing two surgeons’ complete experience with laparoscopic trans-gastric (LaTG) ERCP for biliary and pancreatic duct management.METHODS AND PROCEDURES: Twelve patients underwent LaTG-ERCP.… Continue Reading
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The Predictive Value of Pet/ct Findings Suspicious for Colorectal Cancer in Patients with Non-gastrointestinal Malignancies
Introduction:Positron Emission Tomography/Computed Tomography (PET/CT) performed in the staging and follow-up of patients with non-GI malignancies will occasionally detect a second primary tumor in the GI tract. The purpose of this study was to determine the ability of PET/CT to predict the presence of occult colorectal malignancy in patients already diagnosed with a non-GI cancer.… Continue Reading
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Esophageal Ulcers At a Large Urban Emergency Hospital: A Seventeen Year Experience
OBJECTIVE: In this study, we report the incidence, common etiologies, endoscopic and pathologic findings and clinical outcomes of patients with esophageal ulcers (EU) in our urban population over a seventeen year period. METHODS: This is a retrospective chart review of all upper endoscopies (EGD) performed by a single surgical endoscopist at an urban emergency hospital… Continue Reading
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Inpatient Mortality and Length of Stay Comparison of Percutaneous Endoscopic Gastrostomy and Percutaneous Endoscopic Gastrojejunostomy
Introduction: Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic gastrojejunostomy (PEGJ) are endoscopic procedures often performed by surgeons. No recent population based study has compared inpatient mortality or length of stay between patients who undergo PEG or PEGJ placement during their hospitalization. Methods: Patients undergoing inpatient PEG or PEGJ placement >=18 year old were identified from… Continue Reading
Duodenoscope Choice in Pediatric ERCP
Introduction: Although rare, some pediatric diseases may require diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The choice of duodenoscope for pediatric ERCP is not well studied. This study investigated the hypothesis that a therapeutic adult duoenoscope can be utilized safely for pediatric ERCP. Methods: All patients under the age of 18 were included in this… Continue Reading
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Splenic Injury After Therapeutic ERCP
INTRODUCTION: Endoscopic Retrograde Cholagiopancreatography (ERCP) is an invasive, but sensitive means of diagnosing and treating biliary disease. Complications range from 5-10%. The most common complications of ERCP are acute pancreatitis and duodenal perforation; but esophageal, splenic and hepatic injury have been reported. Here we report such a splenic injury after ERCP. CASE REPORT: A 29… Continue Reading
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Does Preoperative Endoscopy in Bariatric Surgery Alter the Medical or Surgical Strategy?
Introduction: Controversy exists as to the need for preoperative esophago-gastro-duodenoscopy (EGD) for patients undergoing bariatric surgery. Specifically, do findings alter the medical and surgical management. The purpose of this study is to evaluate the role of preoperative EGD in the therapeutic strategy of bariatric surgery. Methods: We conducted a retrospective analysis of consecutive patients undergoing… Continue Reading
Efficacy and Safety in Pediatric ERCP By a Surgical Endoscopist
Introduction: Pediatric endoscopic rertograde cholagiopancreatography (ERCP) is not routinely performed by most therapeutic endoscopists. The challenges of a pediatric anatomy, pediatric physiology, rare indications, and the need for side viewing endoscope preclude this procedure from becoming popular by pediatric gastroenterologist or laparoendoscopic surgeons. This investigation studied the hypothesis that pediatric ERCP can be performed by… Continue Reading
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Feasibility of Transabdominal Diagnostic Peritoneoscopy Using a Flexible Endoscope
Objectives: Diagnostic laparoscopy is an established tool in oncologic evaluation. Standard rigid laparoscopy presents certain limitations in terms of access to various areas of the peritoneal cavity. Other authors have explored the utility of diagnostic laparoscopy with a flexible endoscope via a transgastric or transvaginal approach (NOTES). Our goal is to determine the effectiveness of… Continue Reading
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Feasibility of Diagnostic Peritoneoscopy Using a Flexible Endoscope Under Low Pressure Pneumoperitoneum
Objectives: Standard laparoscopy requires general anesthesia for muscle paralysis to allow for adequate pneumoperitoneum. Our goal is to determine the effectiveness of diagnostic peritoneoscopy using a flexible endoscope under low pressure pneumoperitoneum. Methods: Three 25-kg female swine were subjected to general anesthesia. Pneumoperitoneum to 8mm Hg was achieved with a veress needle. Using a laparoscopic… Continue Reading
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