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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
CASE 2-B.V Path: Tubular Adenoma Plan: EMR of the colon polyp 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 3-M.K 55 y.o M with no significant PMHx c/o regurgitating food at night. EGD/Esophagram: Zenker’s diverticulum 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 3-M.K Plan: Endoscopic Cricopharyngeal myotomy 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 4- T.M 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 4- T.M • Plan: Variceal banding. Examine the Barrett’ s mucosa using Nine-point and obtain targeted biopsies. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
CASE 5-A.H Post op she was noted to have a recto- vaginal fistula. Plan: Attempt endoscopic closure of the fistula. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 6-DG Colonoscopy: 18mm mid ascending colon mass Pathology: Invasive moderately differentiated adenocarcinoma CT abd/pelvis : No evidence of metastatic disease 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 6-DG PLAN: Endoscopic submucosal dissection of ascending colon lesion. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 7-JG 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 7-JG ERCP: 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 7-JG • Plan: EUS guided biliary drainage 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 8 - B.L • Plan: EMR of the colon polyp 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
MRCP images on pancreatic divisum 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 9- R. J. Plan: ERCP with stent placement 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 10-JC Prior treatments with botox and ballon dilatation with only transient relief. Plan: POEM 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 12 - M.M • 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 36th Annual New York Course • December 19-22, 2012
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 New York Society for Gastrointestinal Endoscopy 36th Annual New York Course • December 19-22, 2012
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. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 13 - J. A. Plan: EUS guided cyst gastrostomy 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 14 – M.S. • 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. New York Society for Gastrointestinal Endoscopy 36th Annual New York Course • December 19-22, 2012
Case 14 – M.S. • The biliary obstruction was treated with stent placement using EUS-guided biliary drainage. • PLAN: EUS guided gastro jejunostomy New York Society for Gastrointestinal Endoscopy 36th Annual New York Course • December 19-22, 2012
Case 15 - J.H • 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. New York Society for Gastrointestinal Endoscopy 36th Annual New York Course • December 19-22, 2012
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 New York Society for Gastrointestinal Endoscopy 36th Annual New York Course • December 19-22, 2012
Case 15 - J.H. • Plan: EMR of the lesion New York Society for Gastrointestinal Endoscopy 36th Annual New York Course • December 19-22, 2012
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 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 16 - S. X. 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
Case 16 - S. X. Plan: ERCP with lithotripsy 39 th annual New York Course December 2015 36th Annual New York Course • December 19-22, 2012
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