Dr Jaydeep Patel - Gastroenterology

A 71 year old male presented with pain abdomen, jaundice and fever, underwent MRCP which was suggestive of cystic duct stone and CBD stone. ERCP was done to remove the CBD stone and stent was placed in view of mirrizzi syndrome. Patient underwent laparoscopic cholecystectomy but due to difficult gall bladder partial cholecystectomy was done with removal of gallbladder stone but cystic duct stone couldn't be tackled. Spy glass laser lithotripsy was done, stone fragmented and removed with the help of stone retrieval balloon. Spyglass cholangioscopy done showing clear CBD, CHD and cystic duct junction.

Case capsule - Polypectomy of a large pedunculated polyp with multiple diverticulae in sigmoid colon performed at Aadicura Hospital.
Polyps can be pre cancerous condition. Screening for colonic polyps can prevent development of cancers. Moreover polyps can be removed with the help of endoscopy to prevent their progression to a cancerous lesion.

Procedure performed by team AIGHS at Aadicura Hospital, Vadodara.
A 62 year old female presented with difficulty in swallowing even liquids. On evaluation was found to have cancer of the esophagus (food pipe). Moreover surgery was not possible due to advanced disease, so a metallic stent was put for palliative purpose. Following the procedure the patient was able to tolerate solid foods with ease.

Case capsule:-
Procedure performed at Aadicura Superspeciality Hospital by Team AIGHS
A patient presented with severe abdominal pain diagnosed as acute pancreatitis due to choledocholithiasis (CBD stone) impacted at ampulla. ERCP was done. Precut sphincterotomy was done to deliver the stone followed by sweeping of the bile duct and placing a stent to tide over the acute episode of pancreatitis. Patient had immediate pain relief post procedure.

Aadicura Institute of Gastroenterology and Heptobiliary sciences
AIGHS
Superspeciality hospital

Presents an interesting case -
64 year male CLD NASH induced presented with hemetemesis. Third episode in last few months . Upper g I scopy done at periphery Aadicura speciality clinic showed large Fundic varix with stigmata of haemorrhage . After few days he came to hospital for definitive work up.
16 ml feeder to a 8 ml fundus varix
Patient counselled for options
1- BRTO 2- surgery 3- EUS coil plus glue.
Finally after admission
EUS coiling using 35 mm two coils and n butyl cyanoacrylate glue.
Principle - the coil prevents glue to embolism when in such a large varix we would otherwise need a large volume of glue. Coil acts a scaffold over which glue forms a polymer and the combination acts as a plug.

Comments

EUS guided vascular endotherapy - coil plus glue
Opens a new vista to manage vascular challenges including aneurysms in arteries (gda, splenic etc)and fundus varices.