عيادة د سالم يوسف لامراض الباطنة والجهاز الهضمى

Friday, November 27, 2020

bleeding gastric polyps# in a patient with bleeding varices#


google.com, pub-4485728567761794, DIRECT, f08c47fec0942fa0

Bleeding gastric polyps# in a patient with bleeding esophageal varices#

A 45-year-old man presented with upper GI bleeding was admitted to the endoscopy unit. The patient underwent upper digestive endoscopy. The scope revealed esophageal varices and 3 polyps in the stomach, two of these polyps are bleeding.

What is your opinion?


Sunday, November 22, 2020

tokyo live, one endoscopy#

 google.com, pub-4485728567761794, DIRECT, f08c47fec0942fa0

Tokyo live, one endoscopy# is an interesting gastrointestinal endoscopy meeting, this year it was held online and also it is free. it is an amazing experience 3 days of lectures and workshops from experts of gastroenterology from all overthe world. every year at the same time, so if your are a GI endoscopist do not miss this opportuinity.

the meeting website:http://www.coac.jp/tokyolive/english/


google.com, pub-4485728567761794, DIRECT, f08c47fec0942fa0

https://iabtechlab.com/ads-txt/

Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt

google.com, pub-4485728567761794, DIRECT, f08c47fec0942fa0 

Our original research article is published in theworld journal of gastroenterology#

World J Gastroenterol. Nov 21, 2020; 26(43): 6880-6890
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6880

it is an important issue in the field of gastroenterology and hepatology during the era of COVID19#

Thanks to all the authors of this work

ORCID number: Omar Elshaarawy (0000-0002-6945-6204); Sameh Aldesoky Lashen (0000-0002-8599-1338); Nahed A Makhlouf (0000-0003-2949-4369); Doaa Abdeltawab (0000-0002-1150-1113); Mariam Salah Zaghloul (0000-0002-4244-5396); Rasha M Ahmed (0000-0002-5912-920X); Hayam Fathy (0000-0002-4218-7550); Shimaa Afifi (0000-0001-5937-4240); Muhammad Abdel-Gawad (0000-0002-0204-4715); Eman Abdelsameea (0000-0002-3225-7164); Sherief Abd-Elsalam (0000-0003-4366-2218); Salem Youssef Mohamed (0000-0003-2917-4293); Mohammed Tag-Adeen (0000-0001-9813-3191); Mina Tharwat (0000-0001-9834-1644); Ahmed Alzamzamy (0000-0002-3817-5370); Ahmed Nasr Bekhit (0000-0002-9689-3362); Alshaimaa M Eid (0000-0002-4753-9826); Abeer Awad (0000-0001-9945-9767); Mohammad Aamr (0000-0002-1871-4509); Waleed A Abd El Dayem (0000-0002-4897-2170); Mohamed-Naguib Wifi (0000-0002-3403-7106); Mohamed Alboraie (0000-0002-8490-9822).

the link to the full paper : https://www.wjgnet.com/1007-9327/full/v26/i43/6880.htm


google.com, pub-4485728567761794, DIRECT, f08c47fec0942fa0

Friday, November 13, 2020

#what to do next?

<script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
<!-- gastroenterology -->
<ins class="adsbygoogle"
     style="display:block"
     data-ad-client="ca-pub-4485728567761794"
     data-ad-slot="5026350413"
     data-ad-format="auto"
     data-full-width-responsive="true"></ins>
<script>
     (adsbygoogle = window.adsbygoogle || []).push({});
</script>

What to do next

(The site of previously band ligated cardiac nodule in a patient with bleeding esophageal varices)

13 days after the nodule was ligated, another upper digestive endoscopy was done and revealed the scar of the previous band ligated cardiac nodule

What is your opinion?

1-      Just a follow-up, after what time

2-      Follow-up as scheduled for the varices and each time examine the scar area

3-      More investigations

4-      Ignore


https://youtu.be/VDH3ocuAZcI







Wednesday, November 11, 2020

#stent insertion for #Remnant gastric carcinoma#


<script data-ad-client="ca-pub-4485728567761794" async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>

#Remnant gastric carcinoma#

A 68-year-old man presented with dysphagia was admitted to the gastroenterology unit. The patient gives a history of operated gastric cancer 3 years ago (partial gastrectomy mostly involving the fundus, body, and pylorus). The patient had received chemotherapy and radiotherapy. Also, the patient received target therapy and immunotherapy but, without improvement. The most recent pet CT showed an active tumor in the remaining gastric portion. The patient was advised by his oncologist to undergo upper digestive endoscopy for stent insertion to overcome the obstruction made by the tumor. The patient underwent upper GI endoscopy. The scope showed about 8cm gastric mass that nearly occupying the stomach lumen, besides, the mass easily bleeds on touch. This mass extends to the lower esophagus with a remnant of food in the stomach and lower esophagus. Also, lower esophagus inflammation was detected. Duodenal examination revealed a common pathway extending from the stomach but, after 3 to 4 cm this common pathway is divided into 2 pathways as shown in this video. A safari guidewire was inserted and a partially covered esophageal stent (13 cm long) was deployed into the duodenum (2 cm inside the duodenal lumen) all over the stomach lumen and up to 3 cm inside the esophageal lumen (oral end of the stent).

N.B.

1-To make sure that the distal end of the stent is inserted appropriately into the duodenum this step was done under direct visualization by the endoscope, also the cephalad end of the stent with the help of the fluoroscopy.

2-you can notice that the introduction of the scope into the duodenum is difficult due to the previous operation and the remnant gastric cancer, the endoscopist make an upward movement to get into the duodenum

 

Questions

Do you think that the esophageal stent is the best option for this patient? What about the gastric mega stent?

Is it dysphagia alone or dysphagia and gastroparesis?

What was the type of operation done 3 years ago?

Is the opening between the stomach and duodenum the true pyloric ring or a postoperative one?








Friday, November 6, 2020

#Active variceal bleeding during endoscopy, what is your prompt decision?


Active variceal bleeding during endoscopy, what is your prompt decision
A 64-year-old man presented with upper GI bleeding was admitted to the endoscopy unit. The patient underwent upper digestive endoscopy. The scope revealed esophageal varices with risky signs and white nipple signs. During the introduction of the scope with the rubber bands, active esophageal bleeding occurred. There is no spurter but diffuse bleeding.
What is your decision?
1- Band ligation of the varices at the lower esophageal sphincter.
2- Band ligation of the varices at the site of bleeding.
3- Injection sclerotherapy.
The cause of bleeding during endoscopy is
1-friction from the tip of the rubber band cap.
2- inflation of the esophagus (something like barotrauma)
3-bleeding tendency and risky varices
In your opinion, the bleeding was stopped due to
1- Spontaneously (coagulation factors of the patient)
2- Successful band ligation

Thursday, November 5, 2020

#Nodule at the cardia in a patient with bleeding esophageal varices#


A 64-year-old man presented with recurrent attacks of upper gastrointestinal bleeding was admitted to the GI unit. The patient gives a history of advanced HCC (on supportive treatment) and a similar attack of upper GI bleeding 7 months ago. In the previous attack, upper digestive endoscopy revealed esophageal varices that were ligated at this time. The patient underwent upper GI endoscopy. The scope revealed a nodule at the cardia and large esophageal varices.

What is your opinion?

1-      Band ligation for both the nodule and varices

2-      Band ligation for the varices only, discard the nodule

3-      Band ligation for the varices with biopsies from the nodule

4-      Others


Friday, October 30, 2020

Two esophageal lesions in the upper esophagus#


A 26- year- old man presented with melena was admitted to the GI endoscopy unit. The patient gives a history of operated perforated peptic ulcer. The patient underwent endoscopy that revealed a large duodenal ulcer. Also, the scope showed two reddish lesions in the upper esophagus. The endoscopist cannot see these lesions during the introduction of the scope. With careful examination during withdrawal of the scope, the endoscopist meticulously examines the upper esophagus.
Is it esophageal inlet patches#
Should we classify the esophagus into 3 parts ( upper, middle, lower) and examine each part thoroughly and write in detail this description in the endoscopic report?
Should we recommendfor a withdrawal time (like that of colonoscopy with a shorter time duration) during the examination of the esophagus?