(a) (b) Plate 16.1 Esophageal tear after passage of the echoendoscope.

Size: px

Start display at page:

Download "(a) (b) Plate 16.1 Esophageal tear after passage of the echoendoscope."

Natalie Alexia Harvey
5 years ago
Views:

2 Esophageal stent placed over the site of

1 Plate 16.1 Esophageal tear after passage of the echoendoscope. Plate 11.1 Prophylactic pancreatic duct stents. 3-Fr, 4-cm long single-pigtail stent. 5-Fr, 3-cm long flanged stent. Plate 16.2 Esophageal stent placed over the site of perforation. Gastrointestinal Emergencies, 2nd Edition. Edited by T. C. K. Tham, J. S. A. Collins and R. M. Soetikno 2009 Blackwell Publishing Ltd. ISBN:

Plate 17.1 A. chicken meat bolus impacted above a distal esophageal mucosal (Schatzki) ring (not shown).

3 Characteristic appearance of eosinophilic esophagitis, a clinical condition that underlies many foreign body impactions today.

endoscopic clue to the etiology of impaction, which occurred more distally in this patient (not shown). Plate 17.

2 Plate 17.1 A. chicken meat bolus impacted above a distal esophageal mucosal (Schatzki) ring (not shown). The bolus was grasped using the polypectomy snare and lifted off the distal esophageal stenosis before being removed by mouth using the Roth net. Plate 17.3 Characteristic appearance of eosinophilic esophagitis, a clinical condition that underlies many foreign body impactions today. This endoscopic photograph, depicting multiple rings along the esophageal body, was taken upon introduction of the endoscope in the proximal esophagus and hence provided an endoscopic clue to the etiology of impaction, which occurred more distally in this patient (not shown). Plate 17.2 Endoscopic appearance of a distal esophageal mucosal (Schatzki) ring severed by the passage of the food bolus into the stomach under direct endoscopic visualization, water and air instillation, and gentle pressure by the endoscope tip. Mucosal rings account for many episodes of acute esophageal impaction, typically with a meat bolus (steakhouse syndrome).

Plate 17.4 Food impaction in a patient with severe scleroderma esophagus and secondary esophageal candidiasis.

Careful water instillation allowed the endoscope to break up the food residue that initially appeared as a cast of the esophageal body.

5 Food impaction in a patient with esophageal achalasia.

Because of the associated atony and dilation of the esophageal body, water instillation allowed the endoscope to bypass the impaction and

3 Plate 17.4 Food impaction in a patient with severe scleroderma esophagus and secondary esophageal candidiasis. Note the dilated esophagus and the esophageal mucosal changes consistent with Candida infection. Careful water instillation allowed the endoscope to break up the food residue that initially appeared as a cast of the esophageal body. The repeated use of the Roth retrieval net eventually relieved the patient s impaction and associated acute dysphagia. Plate 17.5 Food impaction in a patient with esophageal achalasia. Note the distorted appearance of the distal esophageal mucosa consistent with stasis esophagitis. Because of the associated atony and dilation of the esophageal body, water instillation allowed the endoscope to bypass the impaction and break up the food residue into small particles. Using the endoscope, the food particles were then pushed into the stomach and relieved the patient s dysphagia. Plate 18.1 Wound dehiscence in the distal esophagus following resection of a diverticulum. The drainage tube in the pleural space is clearly seen. Plate 18.2 Esophageal perforation caused by rigid esophagoscopy.

Plate 18.3 Same patient as in Figure 18.

The stent was removed after 14 weeks, however a persisting fistula revealed a

1 Endoscopic picture of huge fundic varices.

Histoacryl-Lipiodol mixture (Figure 24.6). Plate 24.

4 Plate 18.3 Same patient as in Figure 18.1, showing a Flamingo Wallstent in the distal esophagus covering the perforation. The stent was removed after 14 weeks, however a persisting fistula revealed a retained metallic strand which was endoscopically removed (Figure 18.4). Plate 24.1 Endoscopic picture of huge fundic varices. Venography obtained after complete obliteration therapy using a total of 6 ml Histoacryl-Lipiodol mixture (Figure 24.6). Plate 24.2 Endoscopic pictures showing an acute bleeding from a sclerotherapy-induced ulcer on a varix at the distal esophagus. Immediate control of bleeding by intravariceal injection of 0.5 ml Histoacryl-Lipiodol mixture.

3 Endoscopic pictures showing an acute bleeding

5 Plate 30.1 Sigmoidoscopic appearance of acute severe ulcerative colitis 6 days after IV steroid therapy. Plate 24.3 Endoscopic pictures showing an acute bleeding from huge fundic varices. Immediate control of bleeding is achieved by obliterating the varices using cyanoacrylate glue.

SAGES 2019 Flexible Endoscopy Course for Fellows

SAGES 2019 Flexible Endoscopy Course for Fellows Goals and Objectives: At the end of the course, the MIS fellow will be familiar with GI endoscopes, towers, and the instruments used for endoscopy and endoscopic surgery. The fellow will also be able to