VideoGIE
in the center of the food bolus (Fig. 1A). Next, a tri-prong anchor device (OTSC Anchor, Ovesco Endoscopy AG, Tubingen, Germany) was deployed through the tract (Figs. 1B, C) to secure the food bolus and allow en bloc extraction by traction pull (Figs. 1D, E, and Video 1, available online at www.giejournal.org). Esophageal food impaction can be managed by standard push or extraction techniques in most cases. The push technique may not be feasible for tightly impacted food boluses, which can also be refractory to standard extraction techniques, including snares, nets, suction caps, and large-capacity forceps. In such instances, the burn and anchor method, along with preemptive airway protection, can be useful for extracting a refractory food bolus in a relatively safe and efficient manner. The technique is most suitable for a hard bolus rather than a soft food bolus, which is most challenging to extract.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. George B. Saffouri, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA, Victoria Gomez, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA, James H. Tabibian, MD, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, Louis M. Wong Kee Song, MD, FASGE, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA http://dx.doi.org/10.1016/j.gie.2015.11.020
Successful removal of an esophageal band causing complete esophageal obstruction after variceal ligation
Figure 1. A, Complete esophageal obstruction from band. B, Use of loop cutter to grasp and remove the band. C, 4 weeks after intervention, follow-up examination shows healed mucosa and slight esophageal tapering.
1030 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5 : 2016
www.giejournal.org
VideoGIE
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. A 67-year-old woman with esophageal varices from primary biliary cirrhosis presented to an outside hospital with GI bleeding. Upper endoscopy showed grade 2 esophageal varices without bleeding. Esophageal variceal band ligation was performed. During banding, opposite walls of the esophagus were suctioned, completely occluding the esophagus. Two hours after the procedure, the patient experienced difficulty with controlling secretions; a nasoesophageal tube was placed for suctioning. The patient was transferred to our facility. She experienced hepatic encephalopathy, agitation, and aspiration. Intervention to remove the band was deemed necessary. In the event of recurrent hemorrhage, interventional radiology was on standby for placement of a transjugular intrahepatic portosystemic shunt; fibrin glue was available in the procedure suite. Complete esophageal obstruction from the band was noted during EGD (Fig. 1A; Video 1, available online
at www.giejournal.org). Attempts to remove the band with rat-tooth forceps and hot biopsy forceps were unsuccessful. A reusable loop cutter (Olympus America, Melville, NY) was used to grasp the band and remove it (Fig. 1B). The hook on the bottom jaw of the loop cutter enabled it to get underneath the band for grasping. The underlying tissue was ulcerated and necrotic, but the obstruction resolved. She tolerated secretions and a soft diet. Four weeks later, a repeated examination showed ulcerated tissue healing (Fig. 1C). Esophageal obstruction is a known, rare, adverse event of band ligation. Poor visibility and inadequate sedation are potential causes. The use of a loop cutter is a novel technique for removing a band should such an adverse event arise. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. James T. Kwiatt, MD, GI Associates, LLC, Wauwatosa, Wisconsin, USA, Paul Merchant, BS, Medical College of Wisconsin, Milwaukee, Wisconsin, USA http://dx.doi.org/10.1016/j.gie.2015.11.035
Endoscopic treatment of a chronic fistula by resection and sutured closure
Figure 1. A, Upper endoscopic view confirming location of the fistula adjacent to the gastrojejunal anastomosis. B, After injection of saline solution with methylene blue and 1:100,000 epinephrine, a circumferential incision was made to expose the submucosal plane. C, Removal of the remaining mucosa and fistula tract using a snare.
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
Chronic gastrogastric fistulas are a known adverse event of Roux-en-Y gastric bypass surgery, and endoscopic techniques for fistula closure have had limited efficacy. We show the endoscopic closure of a gastrogastric fistula by resection of the fistula tract with use of a modified submucosal dissection technique and snare cautery, followed by Volume 83, No. 5 : 2016 GASTROINTESTINAL ENDOSCOPY 1031
in the center of the food bolus (Fig. 1A). Next, a tri-prong anchor device (OTSC Anchor, Ovesco Endoscopy AG, Tubingen, Germany) was deployed through the tract (Figs. 1B, C) to secure the food bolus and allow en bloc extraction by traction pull (Figs. 1D, E, and Video 1, available online at www.giejournal.org). Esophageal food impaction can be managed by standard push or extraction techniques in most cases. The push technique may not be feasible for tightly impacted food boluses, which can also be refractory to standard extraction techniques, including snares, nets, suction caps, and large-capacity forceps. In such instances, the burn and anchor method, along with preemptive airway protection, can be useful for extracting a refractory food bolus in a relatively safe and efficient manner. The technique is most suitable for a hard bolus rather than a soft food bolus, which is most challenging to extract.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. George B. Saffouri, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA, Victoria Gomez, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA, James H. Tabibian, MD, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, Louis M. Wong Kee Song, MD, FASGE, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA http://dx.doi.org/10.1016/j.gie.2015.11.020
Successful removal of an esophageal band causing complete esophageal obstruction after variceal ligation
Figure 1. A, Complete esophageal obstruction from band. B, Use of loop cutter to grasp and remove the band. C, 4 weeks after intervention, follow-up examination shows healed mucosa and slight esophageal tapering.
1030 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5 : 2016
www.giejournal.org
VideoGIE
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. A 67-year-old woman with esophageal varices from primary biliary cirrhosis presented to an outside hospital with GI bleeding. Upper endoscopy showed grade 2 esophageal varices without bleeding. Esophageal variceal band ligation was performed. During banding, opposite walls of the esophagus were suctioned, completely occluding the esophagus. Two hours after the procedure, the patient experienced difficulty with controlling secretions; a nasoesophageal tube was placed for suctioning. The patient was transferred to our facility. She experienced hepatic encephalopathy, agitation, and aspiration. Intervention to remove the band was deemed necessary. In the event of recurrent hemorrhage, interventional radiology was on standby for placement of a transjugular intrahepatic portosystemic shunt; fibrin glue was available in the procedure suite. Complete esophageal obstruction from the band was noted during EGD (Fig. 1A; Video 1, available online
at www.giejournal.org). Attempts to remove the band with rat-tooth forceps and hot biopsy forceps were unsuccessful. A reusable loop cutter (Olympus America, Melville, NY) was used to grasp the band and remove it (Fig. 1B). The hook on the bottom jaw of the loop cutter enabled it to get underneath the band for grasping. The underlying tissue was ulcerated and necrotic, but the obstruction resolved. She tolerated secretions and a soft diet. Four weeks later, a repeated examination showed ulcerated tissue healing (Fig. 1C). Esophageal obstruction is a known, rare, adverse event of band ligation. Poor visibility and inadequate sedation are potential causes. The use of a loop cutter is a novel technique for removing a band should such an adverse event arise. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. James T. Kwiatt, MD, GI Associates, LLC, Wauwatosa, Wisconsin, USA, Paul Merchant, BS, Medical College of Wisconsin, Milwaukee, Wisconsin, USA http://dx.doi.org/10.1016/j.gie.2015.11.035
Endoscopic treatment of a chronic fistula by resection and sutured closure
Figure 1. A, Upper endoscopic view confirming location of the fistula adjacent to the gastrojejunal anastomosis. B, After injection of saline solution with methylene blue and 1:100,000 epinephrine, a circumferential incision was made to expose the submucosal plane. C, Removal of the remaining mucosa and fistula tract using a snare.
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
Chronic gastrogastric fistulas are a known adverse event of Roux-en-Y gastric bypass surgery, and endoscopic techniques for fistula closure have had limited efficacy. We show the endoscopic closure of a gastrogastric fistula by resection of the fistula tract with use of a modified submucosal dissection technique and snare cautery, followed by Volume 83, No. 5 : 2016 GASTROINTESTINAL ENDOSCOPY 1031
