Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Extraintestinal Endosonography

Introduction The use of endoscopic ultrasound (EUS) has grown over the last 30 years, and it is now a well-established diagnostic method for the assessment of a range of gastrointestinal (GI) disorders, including the evaluation and staging of many types of endoluminal cancers. This chapter discusses EUS applications relating to extraintestinal structures, organs, and lesions. The objectives of this chapter are to review the utility of…

Endoscopic Full-Thickness Resection of Subepithelial Lesions of the GI Tract

Introduction Over the past 15 years, the role of endoscopy in the removal of large and subepithelial lesions has expanded greatly. Whereas expertise in endoscopic submucosal dissection (ESD) has been long established in Asia, the technique has become more widely available in the West. With expanding indications, including the removal of muscularis propria (MP)-originating subepithelial tumors (SETs), the need for a safe and effective method for…

Intramural and Transmural Endoscopy

Introduction Natural orifice transluminal endoscopic surgery (NOTES) is an evolving concept, combining minimally invasive surgery with flexible endoscopy, potentially representing a major paradigm shift to scarless surgery. Recently, NOTES went from few experimental reports to clinical series and multicentric studies. Since the early concept, from pioneers such as Kalloo and Kantsevoy in the United States, and Rao and Reddy in India, NOTES has emerged as a…

Management of Post-Bariatric Complications

Introduction Obesity is a global epidemic, and has resulted in a substantial increase in the number of bariatric procedures performed worldwide. As the field of bariatric surgery continues to grow with the increasing prevalence of obesity, a greater number of patients are referred for endoscopic evaluation after bariatric surgery. Despite improvement in the performance of bariatric surgery over the past decade, complications from the procedures are…

Endoscopic Techniques for Weight Loss

Introduction Obesity is the pandemic of the 21st century and is associated with considerable morbidity and mortality. Management of obesity depends on body mass index (BMI) and the presence of comorbidities, including heart disease, diabetes, hypertension, dyslipidemia, osteoarthritis, and sleep apnea. Approximately 1.6 billion adults are overweight; at least 400 million adults are obese. The World Health Organization projected that by 2015, approximately 2.3 billion adults…

Techniques in Enteral Access

Introduction Using the gut to provide nutritional therapy by the enteral route plays a pivotal role in patient outcome in the critical care setting. Failure to use the gut for nutrition results in the gut becoming a proinflammatory organ, and results in increasing oxidative stress and higher risk of complications. Early enteral access and utilization of the gut in contrast, promote or support the mass of…

Infections of the Luminal Digestive Tract

Introduction The diagnosis and management of luminal gastrointestinal (GI) tract infections has been an essential component of the practice of gastroenterology since the birth of the subspecialty. The emergence of endoscopy with mucosal biopsy as a safe and accurate diagnostic tool for patients with suspected infection has elevated the GI endoscopist to a key partner in the management team. The importance of the endoscopist may be…

Colonic Strictures

Introduction Colonic strictures are encountered with relative frequency in gastroenterology and colorectal surgery practices. The causes of these strictures are quite varied but the most common etiologies in adults include malignancy, diverticular disease, ischemic injury, inflammatory bowel disease (Crohn's disease), surgical anastomoses, and radiation injury. Less commonly, they can be seen in association with nonsteroidal antiinflammatory drug (NSAID)-induced injury, pancreatitis, endometriosis, and as a complication of…

Dysplasia Surveillance in Inflammatory Bowel Disease

Introduction Patients with long-standing inflammatory bowel disease (IBD) are at an increased risk for development of colorectal cancer (CRC). Risk factors for the development of CRC in ulcerative colitis (UC) or Crohn's colitis include young age of disease onset, longer duration of disease, greater extent of colonic involvement, coexistent primary sclerosing cholangitis (PSC), active endoscopic or histological inflammation, family history of CRC in a first-degree relative…

Endoscopic Diagnosis and Staging of Inflammatory Bowel Disease

Introduction Over the past several decades, endoscopy has become an integral tool for diagnosing inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), and staging disease activity. Both CD and UC are characterized by the presence of intestinal inflammatory changes and ulcerations, which are detected during an endoscopic evaluation and confirmed by histopathology examination of specimens obtained during endoscopy. However, the endoscopic evaluation…

Colonoscopic Polypectomy, Mucosal Resection, and Submucosal Dissection

Introduction Related to the central role of colonoscopy within colorectal cancer (CRC) screening and surveillance, most gastroenterologists spend the majority of their time in the colon looking for and removing neoplastic polyps in an effort to reduce the risk of CRC incidence and death. However, the benefit of colonoscopy in reducing CRC relies on the adequate detection and removal of polyps. Although the majority of CRC…

Colorectal Cancer Screening and Surveillance

Introduction Colorectal cancer (CRC) is a global public health threat. The lifetime risks of an individual developing or dying from CRC are approximately 5% and 2.5%, respectively; worldwide, there are an estimated 1.4 million new cases and 700,000 deaths annually. In the United States, approximately 135,000 new cases and 49,200 deaths were estimated to occur in 2016. The fundamental aim of screening for CRC is to…

Acute Colonic Pseudo-Obstruction

Introduction Acute colonic pseudo-obstruction (ACPO) is a disorder characterized by massive dilation of the colon in the absence of mechanical obstruction. This severe motility disturbance, also known as Ogilvie's syndrome, usually develops in hospitalized patients, and is associated with various medical and surgical conditions. The tension on the colon wall resulting from the extreme dilation can lead to ischemic necrosis and perforation, especially in the cecum.…

Duodenal and Papillary Adenomas

Introduction Duodenal polyps are uncommon. They can be found in 0.3%–4.6% of patients undergoing upper gastrointestinal endoscopy, and are usually an incidental finding. Adenomas account for approximately 7% of all duodenal polyps. They are most commonly found in the second part of the duodenum, and are usually solitary, flat, sessile lesions. Duodenal adenomas can be classified as papillary adenomas (PAs) when primarily involving the papilla Vateri,…

Palliation of Gastric Outlet Obstruction

Malignant Gastric Outlet Obstruction Malignant gastric outlet obstruction (MGOO) is a syndrome caused by intestinal obstruction due to tumor growth in the pyloric region or duodenum ( Fig. 33.1 ). Because of this mechanical obstruction, food and fluids accumulate in the stomach, which results in gastric distention. Patients with MGOO usually present with nausea and vomiting (85%), regurgitation (70%), abdominal pain (65%), and complaints of early…

Diagnosis and Treatment of Superficial Gastric Neoplasms

Introduction The incidence and mortality of gastric cancer have decreased in recent decades because of the reduction of Helicobacter pylori infection, development of endoscopic equipment, and refinement of endoscopic diagnostic and treatment techniques. However, it still remains among the most common malignancies, particularly in Asian countries. Although the prognosis of advanced gastric cancer is poor, the long-term outcome of early gastric cancer is favorable, so it…

Subepithelial Tumors of the Esophagus and Stomach

Introduction Neoplasms of nonepithelial origin, although uncommon, are lesions that a gastrointestinal (GI) endoscopist can expect to encounter with some regularity. Although the number of such pathologic entities is manageably small, the spectrum of clinical behavior manifested by these lesions spans from trivial to life-threatening. The difficulty in managing patients with such lesions is that the tumor originates from within the GI tract wall and often…

Gastric Polyps and Thickened Gastric Folds

Introduction Examination of the stomach by upper endoscopy often results in the incidental finding of gastric polyps or thickened gastric folds. Gastric polyps are estimated to be identified in 6% to 8% of all upper endoscopy exams. Most series report that the most common type of polyp encountered is the fundic gland polyp (FGP) (77% to 80%), followed by the hyperplastic polyp (17% to 19%), though…

Endoscopic Approaches for Gastroparesis

Introduction The word gastroparesis is derived from the Greek words gastro and pa'resis, and translates to partial paralysis of the stomach. The diagnosis of gastroparesis is defined as delayed gastric emptying in the absence of mechanical obstruction, associated with one or more of the following symptoms: postprandial fullness, early satiety, nausea, vomiting, and bloating. Whereas gastroparesis can be associated with diabetes mellitus, neuromuscular and connective tissue…

Palliation of Malignant Dysphagia and Esophageal Fistulas

Introduction The incidence of new cases of esophageal and gastroesophageal junction (GEJ) cancer is estimated to be 450,000 per year worldwide. Esophageal cancer is the eighth most frequent malignancy and has the sixth-highest cancer-specific mortality. The estimated 5-year survival rate in Western countries is less than 20% after the diagnosis. In the past, squamous cell carcinoma (SCC) was responsible for more than 90% of cases of…