VideoGIE
Incorporated Surgical Systems, Marietta, Ga) was used to cut the mucosal bridges (Video 1, available online at www.giejournal.org). The patients both tolerated the procedure well and remained symptom free after the procedure. Endoscopic needle-knife therapy is a valid technique for the management of multicompartment ileal pouch caused by mucosal bridges. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Gang-lei Liu, MD, Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Geriatric Surgery, Second Xiangya Hospital, Central South
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. University, Changsha, China, Xian-rui Wu, MD, PhD, Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA, Bo Shen, MD, FASGE, Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
http://dx.doi.org/10.1016/j.gie.2014.08.034
Cap-assisted argon plasma coagulation
Figure 1. Cap-assisted argon plasma coagulation by use of a single-use, soft, straight cap to ablate radiation proctopathy in a symptomatic 68-year-old man.
Cap-assisted argon plasma coagulation is carried out with a clear cap over the tip of the endoscope. The catheter is then positioned within the cap in such a manner that the tip of the catheter is kept at a reproducible distance from the mucosa (Fig. 1). This obviates the possi-
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
www.giejournal.org
bility of direct mucosal contact and the resulting direct thermal injury. It also allows for a very precise delivery of current to the target tissues by maintaining the position of the endoscope tip and catheter tip relative to the intended treatment area, maintaining luminal patency, and controlling the local gas dynamics of the argon. This technique does not appear to be widely used and has not been described in the medical literature, to our knowledge, but we suspect that some endoscopists may find it helpful. Video 1 (available online at www. giejournal.org) demonstrates this technique by use of a single-use, soft, straight cap (Olympus, Tokyo, Japan) to ablate radiation proctopathy in a symptomatic 68year-old man.
Volume 81, No. 5 : 2015 GASTROINTESTINAL ENDOSCOPY 1279
VideoGIE
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Vikram Budhraja, MD, Shyam Dang, MD, Department of Internal Medicine, Division of Gastroenterology and Hepatol-
ogy, University of Arkansas Medical Sciences, Little Rock, Arkansas
http://dx.doi.org/10.1016/j.gie.2014.09.003
Therapy for recurrent bleeding from rectal varices by EUS-guided sclerosis
Figure 1. EUS, fluoroscopic, and endoscopic images of treatment. Upper left image, EUS guided injection of STS (sodium tetradecyl sulfate); upper right image, fluoroscopy of STS injection; bottom left image, pre-treatment of rectal varices; bottom right image, post-treatment image of rectal varices.
A 64-year-old man with end-stage cirrhosis was admitted with recurrent bleeding from rectal varices. The patient was not a candidate for a transjugular intrahe-
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. 1280 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5 : 2015
patic portosystemic shunt procedure because of a score of 27 on the model for end-stage liver disease. It was decided to pursue endoscopic therapy. Endoscopic evaluation revealed large rectal varices. On rectal EUS, varices were identified in the submucosal layer of the rectal wall. The perirectal collateral and feeding vessels were visualized. With the aid of color Doppler, perforators were identified breaking through the muscularis propria. Endoscopic injection sclerotherapy (EIS) was performed by using sodium tetradecyl sulfate (STS). Two milliliters of STS foam, created by mixing 1 mL of 3% STS www.giejournal.org
Incorporated Surgical Systems, Marietta, Ga) was used to cut the mucosal bridges (Video 1, available online at www.giejournal.org). The patients both tolerated the procedure well and remained symptom free after the procedure. Endoscopic needle-knife therapy is a valid technique for the management of multicompartment ileal pouch caused by mucosal bridges. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Gang-lei Liu, MD, Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Geriatric Surgery, Second Xiangya Hospital, Central South
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. University, Changsha, China, Xian-rui Wu, MD, PhD, Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA, Bo Shen, MD, FASGE, Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
http://dx.doi.org/10.1016/j.gie.2014.08.034
Cap-assisted argon plasma coagulation
Figure 1. Cap-assisted argon plasma coagulation by use of a single-use, soft, straight cap to ablate radiation proctopathy in a symptomatic 68-year-old man.
Cap-assisted argon plasma coagulation is carried out with a clear cap over the tip of the endoscope. The catheter is then positioned within the cap in such a manner that the tip of the catheter is kept at a reproducible distance from the mucosa (Fig. 1). This obviates the possi-
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
www.giejournal.org
bility of direct mucosal contact and the resulting direct thermal injury. It also allows for a very precise delivery of current to the target tissues by maintaining the position of the endoscope tip and catheter tip relative to the intended treatment area, maintaining luminal patency, and controlling the local gas dynamics of the argon. This technique does not appear to be widely used and has not been described in the medical literature, to our knowledge, but we suspect that some endoscopists may find it helpful. Video 1 (available online at www. giejournal.org) demonstrates this technique by use of a single-use, soft, straight cap (Olympus, Tokyo, Japan) to ablate radiation proctopathy in a symptomatic 68year-old man.
Volume 81, No. 5 : 2015 GASTROINTESTINAL ENDOSCOPY 1279
VideoGIE
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Vikram Budhraja, MD, Shyam Dang, MD, Department of Internal Medicine, Division of Gastroenterology and Hepatol-
ogy, University of Arkansas Medical Sciences, Little Rock, Arkansas
http://dx.doi.org/10.1016/j.gie.2014.09.003
Therapy for recurrent bleeding from rectal varices by EUS-guided sclerosis
Figure 1. EUS, fluoroscopic, and endoscopic images of treatment. Upper left image, EUS guided injection of STS (sodium tetradecyl sulfate); upper right image, fluoroscopy of STS injection; bottom left image, pre-treatment of rectal varices; bottom right image, post-treatment image of rectal varices.
A 64-year-old man with end-stage cirrhosis was admitted with recurrent bleeding from rectal varices. The patient was not a candidate for a transjugular intrahe-
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. 1280 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5 : 2015
patic portosystemic shunt procedure because of a score of 27 on the model for end-stage liver disease. It was decided to pursue endoscopic therapy. Endoscopic evaluation revealed large rectal varices. On rectal EUS, varices were identified in the submucosal layer of the rectal wall. The perirectal collateral and feeding vessels were visualized. With the aid of color Doppler, perforators were identified breaking through the muscularis propria. Endoscopic injection sclerotherapy (EIS) was performed by using sodium tetradecyl sulfate (STS). Two milliliters of STS foam, created by mixing 1 mL of 3% STS www.giejournal.org
