We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Gianfranco DONATELLI

Hôpital Privé des Peupliers
Paris, France
MD
2K likes
95.1K views
8 comments
Filter by
Clear filter Specialty
View more

Clear filter Media type
View more
Clear filter Category
View more
Endoscopic internal drainage of gastric fistula after sleeve gastrectomy
Gastric fistula is a major adverse event after sleeve gastrectomy.
In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula.
The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.
Gf Donatelli, S Perretta, M Ignat, M Pizzicannella, D Mutter, J Marescaux
Surgical intervention
3 months ago
598 views
2 likes
0 comments
14:45
Endoscopic internal drainage of gastric fistula after sleeve gastrectomy
Gastric fistula is a major adverse event after sleeve gastrectomy.
In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula.
The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.
EUS gastrojejunal anastomosis with HOT AXIOS® stent after Whipple pancreatectomy, filling blind loop through percutaneous transhepatic biliary drainage
A 67-year-old woman underwent a Whipple pancreatectomy for cancer one year earlier. She was readmitted to hospital for abdominal pain and subocclusion with jaundice. CT-scan showed a dilatation of the jejunal stump with associated biliary tree dilatation. Percutaneous biliary transhepatic drainage (PBTHD) was performed and a stenosis was diagnosed in the afferent loop, accountable for subocclusion and secondary jaundice. Two double pigtails were delivered by the interventional radiologist through PBTHD across the jejunal stricture without resolution of symptoms. Biliary drainage was left in place causing patient discomfort. EUS gastrojejunal anastomosis (GJA) using the HOT AXIOS® stent was attempted in order to bypass the stricture. EUS allows to find the jejunal stump, detected by mechanical staple line visualization. Additionally, the blind loop was detected as it was filled up with liquid and contrast through the PBTHD. The HOT AXIOS® stent was delivered without any complications (VIDEO). Afterwards, flow of bile and liquid was observed through the lumen-apposing metal stent (LAMS). PBTHD was immediately removed. Recovery was uneventful and the patient was discharged on a normal diet with no pain on the following day. EUS-GJA via a LAMS is a well-described technique in experts’ hands (Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Itoi T, Baron TH, Khashab MA, et al. Dig Endosc 2017;29:495-502). Special skills and techniques are necessary in order to recognize the exact small bowel loop to puncture (Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al. Endosc Int Open 2016;4:E276-81). In that case, we show that filling this loop using a previous transhepatic access should be considered an alternative in case of alterated anatomy. Also direct EUS transgastric injection of contrast medium in the dilated biliary tree to fill up the jejunal stump could be considered an option to perform GJA by a single operator in a single session after safely recognizing the right loop. In addition, fluoroscopy helps to detect the exact loop puncture site. In conclusion, GJA using a LAMS is feasible, safe and useful, and transhepatic injection of liquid and contrast medium helps to adequately recognize the jejunal stump after biliopancreatic surgery.
Gf Donatelli, G Pourcher, D Fuks, S Perretta, B Dallemagne, M Pizzicannella
Surgical intervention
3 months ago
68 views
2 likes
0 comments
02:30
EUS gastrojejunal anastomosis with HOT AXIOS® stent after Whipple pancreatectomy, filling blind loop through percutaneous transhepatic biliary drainage
A 67-year-old woman underwent a Whipple pancreatectomy for cancer one year earlier. She was readmitted to hospital for abdominal pain and subocclusion with jaundice. CT-scan showed a dilatation of the jejunal stump with associated biliary tree dilatation. Percutaneous biliary transhepatic drainage (PBTHD) was performed and a stenosis was diagnosed in the afferent loop, accountable for subocclusion and secondary jaundice. Two double pigtails were delivered by the interventional radiologist through PBTHD across the jejunal stricture without resolution of symptoms. Biliary drainage was left in place causing patient discomfort. EUS gastrojejunal anastomosis (GJA) using the HOT AXIOS® stent was attempted in order to bypass the stricture. EUS allows to find the jejunal stump, detected by mechanical staple line visualization. Additionally, the blind loop was detected as it was filled up with liquid and contrast through the PBTHD. The HOT AXIOS® stent was delivered without any complications (VIDEO). Afterwards, flow of bile and liquid was observed through the lumen-apposing metal stent (LAMS). PBTHD was immediately removed. Recovery was uneventful and the patient was discharged on a normal diet with no pain on the following day. EUS-GJA via a LAMS is a well-described technique in experts’ hands (Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Itoi T, Baron TH, Khashab MA, et al. Dig Endosc 2017;29:495-502). Special skills and techniques are necessary in order to recognize the exact small bowel loop to puncture (Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al. Endosc Int Open 2016;4:E276-81). In that case, we show that filling this loop using a previous transhepatic access should be considered an alternative in case of alterated anatomy. Also direct EUS transgastric injection of contrast medium in the dilated biliary tree to fill up the jejunal stump could be considered an option to perform GJA by a single operator in a single session after safely recognizing the right loop. In addition, fluoroscopy helps to detect the exact loop puncture site. In conclusion, GJA using a LAMS is feasible, safe and useful, and transhepatic injection of liquid and contrast medium helps to adequately recognize the jejunal stump after biliopancreatic surgery.
ERCP in a patient with previous subtotal gastrectomy for cancer: hybrid approach with transjejunal access
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior gastric surgery (Roux-en-Y gastric bypass, partial or subtotal gastrectomy) is a challenging procedure. Despite technological advances in endoscopy, reaching the duodenum and entering the bile duct remains difficult. Laparoscopic assisted ERCP (LAERCP) allows the duodenum to be accessed through the excluded stomach in case of previous RYGB or through the proximal jejunum in case of gastric resection. The objective of this video is to demonstrate the hybrid approach in a patient with a previous subtotal gastrectomy for gastric cancer.
A D'Urso, Gf Donatelli, B Dallemagne, D Mutter, J Marescaux
Surgical intervention
3 months ago
80 views
0 likes
0 comments
12:02
ERCP in a patient with previous subtotal gastrectomy for cancer: hybrid approach with transjejunal access
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior gastric surgery (Roux-en-Y gastric bypass, partial or subtotal gastrectomy) is a challenging procedure. Despite technological advances in endoscopy, reaching the duodenum and entering the bile duct remains difficult. Laparoscopic assisted ERCP (LAERCP) allows the duodenum to be accessed through the excluded stomach in case of previous RYGB or through the proximal jejunum in case of gastric resection. The objective of this video is to demonstrate the hybrid approach in a patient with a previous subtotal gastrectomy for gastric cancer.
Large intradiverticulum endoscopic biliary sphincterotomy
Periampullary duodenal diverticula are observed in 10-20% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and could well increase ampulla cannulation failure risk, as well as potential complications related to endoscopic sphincterotomy.
Here we report two successful cases of large intradiverticular endoscopic biliary sphincterotomy in the treatment of two different kinds of benign biliary pathologies. The first case was that of a woman with multiple large stones in the common bile duct (CBD). The second case was one of a male patient with cholestasis due to a compression of the distal common bile duct caused by a diverticulum – this condition being known as Lemmel’s syndrome.
Gf Donatelli, L Marx, J Marescaux
Surgical intervention
2 years ago
1346 views
77 likes
0 comments
05:09
Large intradiverticulum endoscopic biliary sphincterotomy
Periampullary duodenal diverticula are observed in 10-20% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and could well increase ampulla cannulation failure risk, as well as potential complications related to endoscopic sphincterotomy.
Here we report two successful cases of large intradiverticular endoscopic biliary sphincterotomy in the treatment of two different kinds of benign biliary pathologies. The first case was that of a woman with multiple large stones in the common bile duct (CBD). The second case was one of a male patient with cholestasis due to a compression of the distal common bile duct caused by a diverticulum – this condition being known as Lemmel’s syndrome.
Successful closure of iatrogenic colonic perforation with Over-The-Scope Clip™ system (OVESCO™) after failed attempt with standard endoscopic clips
Iatrogenic colonic perforation is a rare complication which has been reported in 0.03%-0.8% of cases during diagnostic colonoscopy. The sigmoid colon and the rectosigmoid junction are the most common sites of perforation during diagnostic examination. Successful endoscopic closure of the defect has been reported using standard clips. However, in case of large defects, standard clips are often ineffective. OTSC™ clips are devices which are successfully used to close wall defects up to 25mm. They make it possible to continue the endoscopic procedure after wall defect closure. In this video, we show the successful closure of a sigmoid colonic iatrogenic perforation in a 50-year-old woman by means of the Over The Scope Clip™ system (OVESCO® Endoscopy, Germany) (11/6 t) after failed attempt with standard clips. OVESCO™ was applied with a standard gastroscope using the suction technique by pushing the cap against the edges of the defect. In order to prevent incarceration of adjacent structures a soft aspiration of the omentum was applied and the OVESCO™ was carefully deployed. Carbon dioxide insufflation was used. Antibiotic therapy was started and the patient was discharged 5 days later. In conclusion, the Over The Scope Clip™ (OTSC™) is a safe surgery-sparing tool which allows for a successful iatrogenic perforation closure of the GI tract, performing omentoplasty by means of a suction technique.
Gf Donatelli
Surgical intervention
3 years ago
1334 views
31 likes
1 comment
02:28
Successful closure of iatrogenic colonic perforation with Over-The-Scope Clip™ system (OVESCO™) after failed attempt with standard endoscopic clips
Iatrogenic colonic perforation is a rare complication which has been reported in 0.03%-0.8% of cases during diagnostic colonoscopy. The sigmoid colon and the rectosigmoid junction are the most common sites of perforation during diagnostic examination. Successful endoscopic closure of the defect has been reported using standard clips. However, in case of large defects, standard clips are often ineffective. OTSC™ clips are devices which are successfully used to close wall defects up to 25mm. They make it possible to continue the endoscopic procedure after wall defect closure. In this video, we show the successful closure of a sigmoid colonic iatrogenic perforation in a 50-year-old woman by means of the Over The Scope Clip™ system (OVESCO® Endoscopy, Germany) (11/6 t) after failed attempt with standard clips. OVESCO™ was applied with a standard gastroscope using the suction technique by pushing the cap against the edges of the defect. In order to prevent incarceration of adjacent structures a soft aspiration of the omentum was applied and the OVESCO™ was carefully deployed. Carbon dioxide insufflation was used. Antibiotic therapy was started and the patient was discharged 5 days later. In conclusion, the Over The Scope Clip™ (OTSC™) is a safe surgery-sparing tool which allows for a successful iatrogenic perforation closure of the GI tract, performing omentoplasty by means of a suction technique.
Diagnosis and treatment of symptomatic common bile duct stones following cholecystectomy by means of EUS and ERCP
A post-cholecystectomy syndrome is a well-known condition, which includes dyspepsia and biliary-like abdominal pain coupled with deterioration of liver enzymes. Biliary factors responsible for a post-cholecystectomy syndrome could be the following: biliary iatrogenic duct strictures, retained stones in the common bile duct (CBD), cystic stump, or even a gallbladder remnant.
The diagnosis of stones is difficult to establish considering that even trans-abdominal ultrasonography has a diagnostic sensitivity of only 27%. Conversely, endoscopic ultrasound (EUS) is a very useful tool to diagnose stones in such situations, allowing to perform subsequent ERCP and stone extraction during the same anesthetic session. Here, we report the case of a 69-year-old man who underwent laparoscopic cholecystectomy and who was referred to us after 24 hours of abdominal colic pain and cholestasis. He underwent EUS, which diagnosed residual common bile duct stones. As a result, treatment was performed by means of ERCP during the same session.
Gf Donatelli, F Cereatti, B Meduri
Surgical intervention
4 years ago
1433 views
62 likes
0 comments
03:26
Diagnosis and treatment of symptomatic common bile duct stones following cholecystectomy by means of EUS and ERCP
A post-cholecystectomy syndrome is a well-known condition, which includes dyspepsia and biliary-like abdominal pain coupled with deterioration of liver enzymes. Biliary factors responsible for a post-cholecystectomy syndrome could be the following: biliary iatrogenic duct strictures, retained stones in the common bile duct (CBD), cystic stump, or even a gallbladder remnant.
The diagnosis of stones is difficult to establish considering that even trans-abdominal ultrasonography has a diagnostic sensitivity of only 27%. Conversely, endoscopic ultrasound (EUS) is a very useful tool to diagnose stones in such situations, allowing to perform subsequent ERCP and stone extraction during the same anesthetic session. Here, we report the case of a 69-year-old man who underwent laparoscopic cholecystectomy and who was referred to us after 24 hours of abdominal colic pain and cholestasis. He underwent EUS, which diagnosed residual common bile duct stones. As a result, treatment was performed by means of ERCP during the same session.
Endoscopic biliary stones extraction using a forward viewing standard gastroscope in a patient with altered anatomy (partial gastrectomy with Billroth II reconstruction)
Endoscopic retrograde cholangiography in case of altered anatomy such as partial gastrectomy with Billroth II reconstruction has a success rate of 85% due to different factors such as failure to cross the anastomosis and the presence of an important length of afferent loop with a high risk of jejunal perforation at (or near) the anastomotic site while advancing the duodenoscope. The use of a front-view scope is the safest and could be used theoretically. However, the lack of elevator, the inability to see the papilla in a direct view, and the limited number of catheters available for cannulation and therapeutic procedures in the standard gastroscope with the 2.8mm working channel, can make this kind of procedure quite challenging. In this video, we present a case of successful biliary stone extraction in a patient with Billroth II reconstruction using a standard 2.8mm working channel front-viewing scope.
Gf Donatelli, BM Vergeau, B Meduri
Surgical intervention
4 years ago
865 views
14 likes
0 comments
04:47
Endoscopic biliary stones extraction using a forward viewing standard gastroscope in a patient with altered anatomy (partial gastrectomy with Billroth II reconstruction)
Endoscopic retrograde cholangiography in case of altered anatomy such as partial gastrectomy with Billroth II reconstruction has a success rate of 85% due to different factors such as failure to cross the anastomosis and the presence of an important length of afferent loop with a high risk of jejunal perforation at (or near) the anastomotic site while advancing the duodenoscope. The use of a front-view scope is the safest and could be used theoretically. However, the lack of elevator, the inability to see the papilla in a direct view, and the limited number of catheters available for cannulation and therapeutic procedures in the standard gastroscope with the 2.8mm working channel, can make this kind of procedure quite challenging. In this video, we present a case of successful biliary stone extraction in a patient with Billroth II reconstruction using a standard 2.8mm working channel front-viewing scope.
Single stage diagnosis and treatment by EUS and ERCP of a pancreatic stone causing an acute pancreatitis
Biliopancreatic stones are the ‘primum movens’ of acute pancreatitis. Pure pancreatic stones are rare. However, when present, they are the main cause of acute obstruction of the main pancreatic duct. Conversely, when present in chronic pancreatitis, they are mostly responsible for pancreatic glandular insufficiency. Medical treatment, radiologic evaluation (by MRI or CT-scan), and therapeutic endoscopy constitute the standard of care (SOC).
Here, we report the case of a 25-year-old man, admitted for upper middle abdominal pain and hyperamylasemia, without anomalies in liver function tests, and who underwent biliopancreatic EUS. A pancreatic stone was diagnosed and immediately treated by endoscopic pancreatic sphincterotomy and extraction.
Gf Donatelli, B Meduri
Surgical intervention
4 years ago
1153 views
41 likes
0 comments
05:10
Single stage diagnosis and treatment by EUS and ERCP of a pancreatic stone causing an acute pancreatitis
Biliopancreatic stones are the ‘primum movens’ of acute pancreatitis. Pure pancreatic stones are rare. However, when present, they are the main cause of acute obstruction of the main pancreatic duct. Conversely, when present in chronic pancreatitis, they are mostly responsible for pancreatic glandular insufficiency. Medical treatment, radiologic evaluation (by MRI or CT-scan), and therapeutic endoscopy constitute the standard of care (SOC).
Here, we report the case of a 25-year-old man, admitted for upper middle abdominal pain and hyperamylasemia, without anomalies in liver function tests, and who underwent biliopancreatic EUS. A pancreatic stone was diagnosed and immediately treated by endoscopic pancreatic sphincterotomy and extraction.
Endoscopic internal drainage (EID) for leaks following sleeve gastrectomy
Leaks following sleeve gastrectomy represent a serious problem for surgeons, since a standardized approach has not yet been established.
Usually laparoscopic exploration is necessary in order to achieve a diagnostic peritoneal lavage, and a surgical drain is left in place proximally to the suture line, at the level of the dehiscence (if visualized), jejunostomy is also frequently performed to ensure enteral alimentation. This treatment however, needs to be combined with an endoscopic treatment, in order to facilitate rapid closure of gastric staple line defects.
In this video we report our Endoscopic Internal Drainage (EID) technique by insertion of double pigtail stents combined for the firsts weeks with enteral nutrition, with the aim to create an internal fistula allowing to quickly remove the surgical drain, and promote the formation of granulation tissue at the level of the dehiscence.
Reference:
Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Obes Surg 2014;24:1400-7.
Gf Donatelli
Surgical intervention
4 years ago
922 views
22 likes
0 comments
06:33
Endoscopic internal drainage (EID) for leaks following sleeve gastrectomy
Leaks following sleeve gastrectomy represent a serious problem for surgeons, since a standardized approach has not yet been established.
Usually laparoscopic exploration is necessary in order to achieve a diagnostic peritoneal lavage, and a surgical drain is left in place proximally to the suture line, at the level of the dehiscence (if visualized), jejunostomy is also frequently performed to ensure enteral alimentation. This treatment however, needs to be combined with an endoscopic treatment, in order to facilitate rapid closure of gastric staple line defects.
In this video we report our Endoscopic Internal Drainage (EID) technique by insertion of double pigtail stents combined for the firsts weeks with enteral nutrition, with the aim to create an internal fistula allowing to quickly remove the surgical drain, and promote the formation of granulation tissue at the level of the dehiscence.
Reference:
Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Obes Surg 2014;24:1400-7.
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Gf Donatelli, P Dhumane, S Perretta, BM Vergeau, JL Dumont, T Tuszynski, B Meduri
Surgical intervention
4 years ago
880 views
13 likes
0 comments
04:09
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Esophageal peptic stricture and shortened esophagus managed by a laparoscopic Collis-Nissen procedure
This video presents a laparoscopic Collis-Nissen procedure performed in a 64-year-old man presenting with long-standing reflux disease and esophageal peptic stricture. The patient underwent several (>15) endoscopic dilatations that elicit only temporary improvement of dysphagia. Two esophageal stents were placed without significant improvement after removal. The patient was then referred to surgery. The treatment alternatives were esophagectomy or anti-reflux surgery associated with postoperative dilatations. The first choice was to perform an anti-reflux procedure in order to stop a mixed pathological reflux and reduce the risk of re-stricture. Three months after the procedure, an esophageal stent was placed to dilate the stricture.
B Dallemagne, S Perretta, Gf Donatelli, J Marescaux
Surgical intervention
7 years ago
3315 views
73 likes
0 comments
24:49
Esophageal peptic stricture and shortened esophagus managed by a laparoscopic Collis-Nissen procedure
This video presents a laparoscopic Collis-Nissen procedure performed in a 64-year-old man presenting with long-standing reflux disease and esophageal peptic stricture. The patient underwent several (>15) endoscopic dilatations that elicit only temporary improvement of dysphagia. Two esophageal stents were placed without significant improvement after removal. The patient was then referred to surgery. The treatment alternatives were esophagectomy or anti-reflux surgery associated with postoperative dilatations. The first choice was to perform an anti-reflux procedure in order to stop a mixed pathological reflux and reduce the risk of re-stricture. Three months after the procedure, an esophageal stent was placed to dilate the stricture.
Gastric mucosal laceration managed with endoscopic clipping during ESD in a patient with Child Class A liver cirrhosis
Patients with liver cirrhosis present with portal hypertension (PHT), which causes various pathological changes in the entire gastrointestinal tract (from esophagus to anus). In this video, the Mallory Weiss tear (MWT) occurred accidentally during ESD of a gastric antral adenoma in a cirrhotic patient. It was successfully managed by means of endoscopic clipping. The patient had two episodes of retching during endoscopy, which might have contributed to gastric over-distension. With esophagogastroduodenoscopy (EGD) being so commonly performed in cirrhotic patients and ESD being more and more commonly used for treatment of gastric mucosal lesions, this case report should serve as a precautionary reminder in such case scenarios.
Gf Donatelli, P Dhumane, L Marx, B Dallemagne, J Marescaux
Surgical intervention
7 years ago
767 views
11 likes
0 comments
02:57
Gastric mucosal laceration managed with endoscopic clipping during ESD in a patient with Child Class A liver cirrhosis
Patients with liver cirrhosis present with portal hypertension (PHT), which causes various pathological changes in the entire gastrointestinal tract (from esophagus to anus). In this video, the Mallory Weiss tear (MWT) occurred accidentally during ESD of a gastric antral adenoma in a cirrhotic patient. It was successfully managed by means of endoscopic clipping. The patient had two episodes of retching during endoscopy, which might have contributed to gastric over-distension. With esophagogastroduodenoscopy (EGD) being so commonly performed in cirrhotic patients and ESD being more and more commonly used for treatment of gastric mucosal lesions, this case report should serve as a precautionary reminder in such case scenarios.
Emergency endoscopic esophageal variceal band ligation for active bleeding
Upper digestive bleeding is a frequent complication in cirrhotic patients. In some cases, it can be disastrous with collapse, especially considering coagulopathies in these patients. The management must be multidisciplinary involving an anesthesiologist, an endoscopist, and sometimes an interventional radiologist.
Emergency variceal band ligation is the first step to achieve hemostasis once the patient has been medically stabilized.
This video presents the case of a 91-year-old cirrhotic man, presenting with hepatitis C virus (HCV). He was admitted to the emergency department for massive hematemesis. Blood tests showed hemoglobin levels at 8 g/dL and the patient was hemodynamically stable. Sandostatin® injection, proton pump inhibitors (PPI), antibiotics, vitamin K were started immediately to a full dose regimen. Once fresh frozen plasma and blood transfusion have been carried out, an endoscopy was scheduled within the first 12 hours.
Gf Donatelli, L Marx, J Marescaux
Surgical intervention
7 years ago
1602 views
26 likes
0 comments
02:05
Emergency endoscopic esophageal variceal band ligation for active bleeding
Upper digestive bleeding is a frequent complication in cirrhotic patients. In some cases, it can be disastrous with collapse, especially considering coagulopathies in these patients. The management must be multidisciplinary involving an anesthesiologist, an endoscopist, and sometimes an interventional radiologist.
Emergency variceal band ligation is the first step to achieve hemostasis once the patient has been medically stabilized.
This video presents the case of a 91-year-old cirrhotic man, presenting with hepatitis C virus (HCV). He was admitted to the emergency department for massive hematemesis. Blood tests showed hemoglobin levels at 8 g/dL and the patient was hemodynamically stable. Sandostatin® injection, proton pump inhibitors (PPI), antibiotics, vitamin K were started immediately to a full dose regimen. Once fresh frozen plasma and blood transfusion have been carried out, an endoscopy was scheduled within the first 12 hours.
Single stage laparo-endoscopic management of acute cholecystitis and common bile duct stones
This video demonstrates the case of a 27-year-old woman, admitted to the emergency department for acute right hypochondrium pain.
Clinical examination found a positive Murphy’s sign. Biological findings showed a cholestasis (Gamma Glutamyl Transferase at 576 l/U, Alkaline Phosphatase at 346 l/U), and cytolysis (AST at 460 I/U, ALT at 635 I/U) without jaundice.
Abdominal ultrasonography confirmed the presence of acute cholecystitis with thickening of the gallbladder wall associated with a moderate 8mm dilatation of the common bile duct without any lithiasis.
Antibiotic therapy was started and cholecystectomy with intraoperative cholangiography was decided upon because of the clinical presentation and biological disturbance.
Gf Donatelli, L Marx, C Callari, J Marescaux
Surgical intervention
7 years ago
2005 views
9 likes
0 comments
04:38
Single stage laparo-endoscopic management of acute cholecystitis and common bile duct stones
This video demonstrates the case of a 27-year-old woman, admitted to the emergency department for acute right hypochondrium pain.
Clinical examination found a positive Murphy’s sign. Biological findings showed a cholestasis (Gamma Glutamyl Transferase at 576 l/U, Alkaline Phosphatase at 346 l/U), and cytolysis (AST at 460 I/U, ALT at 635 I/U) without jaundice.
Abdominal ultrasonography confirmed the presence of acute cholecystitis with thickening of the gallbladder wall associated with a moderate 8mm dilatation of the common bile duct without any lithiasis.
Antibiotic therapy was started and cholecystectomy with intraoperative cholangiography was decided upon because of the clinical presentation and biological disturbance.
Management of transpyloric invagination of a gastrointestinal stromal tumor (GIST)
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs are most commonly found in the stomach (40-70%), but can occur in all other parts of the GI tract, with 20 to 40% of GISTs arising in the small intestine and 5 to 15% from the colon and rectum.
They typically grow endophytically, parallel to the bowel lumen, commonly with overlying mucosal necrosis and ulceration. They also vary in size, from a few millimeters to 40cm in diameter. Many GISTs are well defined by a thin pseudo-capsule.
Over 95% of patients present with a solitary primary tumor, and in 10 to 40% of these cases, the tumor directly invades neighboring organs. Gastric GISTs are usually presented with GI bleeding and abdominal pain. However, most patients are symptom-free and the lesions are discovered incidentally during an upper endoscopy performed for other reasons (chronic abdominal pain and intermittent gastric obstruction in this patient).
Surgery remains the mainstay of curative treatment.
Surgical resection of localized gastric GISTs is the preferred treatment modality, as resection of the tumor renders the only chance for cure at this time. Historically, a 1 to 2cm margin was thought to be necessary for an adequate resection. However, more recently, DeMatteo et al. demonstrated that tumor size and not negative microscopic surgical margins determine survival.
It is therefore accepted that the surgical goal should be a complete resection with gross negative margins only.
Given this, wedge resection has been advocated by many investigators for the majority of gastric GISTs.
J D'Agostino, Gf Donatelli, S Perretta, J Marescaux
Surgical intervention
7 years ago
2087 views
19 likes
0 comments
04:15
Management of transpyloric invagination of a gastrointestinal stromal tumor (GIST)
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs are most commonly found in the stomach (40-70%), but can occur in all other parts of the GI tract, with 20 to 40% of GISTs arising in the small intestine and 5 to 15% from the colon and rectum.
They typically grow endophytically, parallel to the bowel lumen, commonly with overlying mucosal necrosis and ulceration. They also vary in size, from a few millimeters to 40cm in diameter. Many GISTs are well defined by a thin pseudo-capsule.
Over 95% of patients present with a solitary primary tumor, and in 10 to 40% of these cases, the tumor directly invades neighboring organs. Gastric GISTs are usually presented with GI bleeding and abdominal pain. However, most patients are symptom-free and the lesions are discovered incidentally during an upper endoscopy performed for other reasons (chronic abdominal pain and intermittent gastric obstruction in this patient).
Surgery remains the mainstay of curative treatment.
Surgical resection of localized gastric GISTs is the preferred treatment modality, as resection of the tumor renders the only chance for cure at this time. Historically, a 1 to 2cm margin was thought to be necessary for an adequate resection. However, more recently, DeMatteo et al. demonstrated that tumor size and not negative microscopic surgical margins determine survival.
It is therefore accepted that the surgical goal should be a complete resection with gross negative margins only.
Given this, wedge resection has been advocated by many investigators for the majority of gastric GISTs.
Loop-and-let-go technique for symptomatic descending colonic lipoma
Large symptomatic colonic lipomas require treatment, but resection of lipomas by means of endoscopic cautery snare carries some risk of colonic perforation. The loop-and-let-go technique described here is technically simple; anyone who is well acquainted with the snare cautery technique can do it. It looks safer than the conventionally employed snare cautery technique, as no current is used with the loop-and-let-go technique. It causes selective occlusive ischemia of mucosa and submucosa without causing any transmural damage. The total duration needed for the lipoma to slough off depends on the quality of endoloop occlusion and the type of lipoma (narrow-based vs wide-based).
Gf Donatelli, P Dhumane, L Marx, J D'Agostino, D Mutter, J Marescaux
Surgical intervention
7 years ago
891 views
3 likes
0 comments
02:16
Loop-and-let-go technique for symptomatic descending colonic lipoma
Large symptomatic colonic lipomas require treatment, but resection of lipomas by means of endoscopic cautery snare carries some risk of colonic perforation. The loop-and-let-go technique described here is technically simple; anyone who is well acquainted with the snare cautery technique can do it. It looks safer than the conventionally employed snare cautery technique, as no current is used with the loop-and-let-go technique. It causes selective occlusive ischemia of mucosa and submucosa without causing any transmural damage. The total duration needed for the lipoma to slough off depends on the quality of endoloop occlusion and the type of lipoma (narrow-based vs wide-based).
Endoscopic management of cystic duct leakage after cholecystectomy
Biliary leaks still represent a significant problem following open or laparoscopic cholecystectomy. The incidence of bile duct leaks after such operations was reported to range between 0.3 and 1%. This video presents the case of a 75-year-old man who was referred to our department for fever, jaundice, and abdominal pain 12 days after laparoscopic cholecystectomy. A cholangio-MRI was carried out. It demonstrated an intra-abdominal biliary collection at the level of the gallbladder bed. A leak from the cystic duct was suspected. A radiological drainage of the collection was performed, and an endoscopic sphincterotomy with plastic stenting of the common bile duct was achieved. The patient went clinically well and at 2 months, the stent was removed. Two months after stent removal, he is totally symptom-free.
Gf Donatelli, L Marx, D Mutter, J Marescaux
Surgical intervention
7 years ago
1877 views
4 likes
1 comment
02:55
Endoscopic management of cystic duct leakage after cholecystectomy
Biliary leaks still represent a significant problem following open or laparoscopic cholecystectomy. The incidence of bile duct leaks after such operations was reported to range between 0.3 and 1%. This video presents the case of a 75-year-old man who was referred to our department for fever, jaundice, and abdominal pain 12 days after laparoscopic cholecystectomy. A cholangio-MRI was carried out. It demonstrated an intra-abdominal biliary collection at the level of the gallbladder bed. A leak from the cystic duct was suspected. A radiological drainage of the collection was performed, and an endoscopic sphincterotomy with plastic stenting of the common bile duct was achieved. The patient went clinically well and at 2 months, the stent was removed. Two months after stent removal, he is totally symptom-free.
Endoscopic intragastric balloon as a bridge to bariatric surgery for the management of a superobese patient
The use of an air-filled intragastric balloon is effective in achieving a relevant loss of body weight. It is used as a bridge to definitive surgery in superobese patients for whom surgery is often associated with high risks. The balloon helps reduce the volume of the stomach and leads to a premature feeling of satiety. These endoscopic bariatric bridging procedures can reduce the overall risk related to the surgical intervention, as measured by the use of the American Society of Anesthesiologists Physical Status Classification System, and promote cardiopulmonary and metabolic improvement. By reducing truncal/visceral obesity, these endoscopic bariatric procedures can ease off technical difficulties related to subsequent surgical interventions.
In this video, we show the case of a 44-year-old superobese man with a BMI of 63, presenting with diabetes mellitus and obstructive sleep apnea, in which a Heliosphere® BAG Pre OP balloon was positioned with the objective of weight reduction.
The procedure is performed under general anesthesia with orotracheal intubation, and with the patient in supine position. Upper endoscopy did not show any lesions or any contraindications to the gastric balloon implantation.
All the procedure is carried out under endoscopic control. In retroversion, good positioning of the inflated balloon is controlled at the level of the fundus floating freely.
PPI drugs are administered throughout the procedure.
The patient is discharged on postoperative day one after starting a liquid diet, and on the following day, he is on a normal hypocaloric diet.
The patient is scheduled to have the Heliosphere® BAG Pre OP removed within six months.
Gf Donatelli, L Marx, C Callari
Surgical intervention
7 years ago
1291 views
9 likes
0 comments
02:14
Endoscopic intragastric balloon as a bridge to bariatric surgery for the management of a superobese patient
The use of an air-filled intragastric balloon is effective in achieving a relevant loss of body weight. It is used as a bridge to definitive surgery in superobese patients for whom surgery is often associated with high risks. The balloon helps reduce the volume of the stomach and leads to a premature feeling of satiety. These endoscopic bariatric bridging procedures can reduce the overall risk related to the surgical intervention, as measured by the use of the American Society of Anesthesiologists Physical Status Classification System, and promote cardiopulmonary and metabolic improvement. By reducing truncal/visceral obesity, these endoscopic bariatric procedures can ease off technical difficulties related to subsequent surgical interventions.
In this video, we show the case of a 44-year-old superobese man with a BMI of 63, presenting with diabetes mellitus and obstructive sleep apnea, in which a Heliosphere® BAG Pre OP balloon was positioned with the objective of weight reduction.
The procedure is performed under general anesthesia with orotracheal intubation, and with the patient in supine position. Upper endoscopy did not show any lesions or any contraindications to the gastric balloon implantation.
All the procedure is carried out under endoscopic control. In retroversion, good positioning of the inflated balloon is controlled at the level of the fundus floating freely.
PPI drugs are administered throughout the procedure.
The patient is discharged on postoperative day one after starting a liquid diet, and on the following day, he is on a normal hypocaloric diet.
The patient is scheduled to have the Heliosphere® BAG Pre OP removed within six months.
Right colon Dieulafoy's lesion: endoscopic treatment
A 78-year-old man presenting with chronic renal failure was admitted to the emergency department of our hospital for bleeding per rectum.
The hemoglobin level was 10.5 g/dL on admission. Given that the patient was hemodynamically stable, decision was made to perform an upper GI endoscopy and a total colonoscopy the following day after standard bowel preparation. Bleeding recurred during the night with a hemoglobin drop to 6.3g/dL, requiring transfusions of 3 Units of blood.
With no further delay, endoscopy was performed. The gastroscopy was normal but at colonoscopy old blood was visualized in the rectum, the sigmoid, and the left and transverse colon. Additional bright red blood was observed at the level of the right colon.
Gf Donatelli, S Perretta, B Dallemagne
Surgical intervention
7 years ago
1589 views
16 likes
1 comment
02:32
Right colon Dieulafoy's lesion: endoscopic treatment
A 78-year-old man presenting with chronic renal failure was admitted to the emergency department of our hospital for bleeding per rectum.
The hemoglobin level was 10.5 g/dL on admission. Given that the patient was hemodynamically stable, decision was made to perform an upper GI endoscopy and a total colonoscopy the following day after standard bowel preparation. Bleeding recurred during the night with a hemoglobin drop to 6.3g/dL, requiring transfusions of 3 Units of blood.
With no further delay, endoscopy was performed. The gastroscopy was normal but at colonoscopy old blood was visualized in the rectum, the sigmoid, and the left and transverse colon. Additional bright red blood was observed at the level of the right colon.
Endoscopic removal of accidentally swallowed dentures
Foreign body ingestion occurs more commonly in children with a peak incidence in the age group of 6 months to 3 years. In adults, it occurs mostly in edentulous patients, prisoners and psychiatric patients.
80-90% of the foreign bodies that reach the gastrointestinal tract will pass spontaneously; 10-20 % will have to be removed endoscopically and unfortunately, 1% requires surgery.
The decision and timing of endoscopic intervention depends on the patient’s age, clinical condition, size, shape and classification of ingested material, anatomical location, risk of aspiration and/or perforation and technical abilities of the endoscopist.
Accidentally swallowed dentures can lead to severe complications in the gastrointestinal tract, such as perforation that needs surgical intervention.
In this video, we present the endoscopic removal of a fixed four-dental prosthesis accidentally swallowed and blocked in the prepyloric zone.

Reference:
Management of foreign bodies of the upper gastrointestinal tract: update. William A. Webb Gastrointestinal Endoscopy, Vol 41, No.1, 1995.
Gf Donatelli, P Dhumane, C Callari, B Dallemagne, J Marescaux
Surgical intervention
8 years ago
1591 views
4 likes
0 comments
02:39
Endoscopic removal of accidentally swallowed dentures
Foreign body ingestion occurs more commonly in children with a peak incidence in the age group of 6 months to 3 years. In adults, it occurs mostly in edentulous patients, prisoners and psychiatric patients.
80-90% of the foreign bodies that reach the gastrointestinal tract will pass spontaneously; 10-20 % will have to be removed endoscopically and unfortunately, 1% requires surgery.
The decision and timing of endoscopic intervention depends on the patient’s age, clinical condition, size, shape and classification of ingested material, anatomical location, risk of aspiration and/or perforation and technical abilities of the endoscopist.
Accidentally swallowed dentures can lead to severe complications in the gastrointestinal tract, such as perforation that needs surgical intervention.
In this video, we present the endoscopic removal of a fixed four-dental prosthesis accidentally swallowed and blocked in the prepyloric zone.

Reference:
Management of foreign bodies of the upper gastrointestinal tract: update. William A. Webb Gastrointestinal Endoscopy, Vol 41, No.1, 1995.
Endoscopic extraction of a giant common bile duct stone
The Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has become the gold standard for the treatment of cholelithiasis with a success rate of 95%.
The dimensions of a giant biliary calculus are equal to or bigger than 2cm.
Various endoscopic tools such as the mechanical lithotripsy or extracorporeal shock wave lithotripsy (ESWL) have been described to treat this pathology. Surgery is offered to cases unresolved by endoscopic therapy.
Recently, the sphincteroplasty with a large-size balloon dilatation of the papilla has been described as an option for the endoscopic management of the giant biliary stone.
This is a case of extraction of giant common bile duct calculus using the combination of sphincterotomy and large-size balloon sphincteroplasty.
Gf Donatelli, P Dhumane, S Perretta, B Dallemagne, J Marescaux
Surgical intervention
8 years ago
2756 views
17 likes
0 comments
03:56
Endoscopic extraction of a giant common bile duct stone
The Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has become the gold standard for the treatment of cholelithiasis with a success rate of 95%.
The dimensions of a giant biliary calculus are equal to or bigger than 2cm.
Various endoscopic tools such as the mechanical lithotripsy or extracorporeal shock wave lithotripsy (ESWL) have been described to treat this pathology. Surgery is offered to cases unresolved by endoscopic therapy.
Recently, the sphincteroplasty with a large-size balloon dilatation of the papilla has been described as an option for the endoscopic management of the giant biliary stone.
This is a case of extraction of giant common bile duct calculus using the combination of sphincterotomy and large-size balloon sphincteroplasty.
Tips 'n tricks: successful ERCP in the presence of periampullary diverticula
Duodenal diverticula are found in approximately 10-20% of patients undergoing Endoscopic Retrograde Cholangio-Pancreatography (ERCP).
Usually, these diverticula lie within 2cm of the major duodenal papilla and are called juxtapapillary diverticula. They are mostly acquired and their incidence increases with age.
Juxtapapillary diverticula have often been associated with mechanical compression and they are also involved in Oddi’s sphincter dysfunction. The presence of juxtapapillary diverticula is known to influence the outcome of ERCP procedure by making it more difficult and causing some complications like bleeding. Various techniques have been advised for a more successful ERCP outcome
In this video, four cases of duodenal diverticula are presented to provide tips and tricks for the successful cannulation of the CBD and management of periampullary bleeding in case they occur.
Gf Donatelli, P Dhumane, S Perretta, B Dallemagne, J Marescaux
Surgical intervention
8 years ago
2064 views
10 likes
0 comments
09:19
Tips 'n tricks: successful ERCP in the presence of periampullary diverticula
Duodenal diverticula are found in approximately 10-20% of patients undergoing Endoscopic Retrograde Cholangio-Pancreatography (ERCP).
Usually, these diverticula lie within 2cm of the major duodenal papilla and are called juxtapapillary diverticula. They are mostly acquired and their incidence increases with age.
Juxtapapillary diverticula have often been associated with mechanical compression and they are also involved in Oddi’s sphincter dysfunction. The presence of juxtapapillary diverticula is known to influence the outcome of ERCP procedure by making it more difficult and causing some complications like bleeding. Various techniques have been advised for a more successful ERCP outcome
In this video, four cases of duodenal diverticula are presented to provide tips and tricks for the successful cannulation of the CBD and management of periampullary bleeding in case they occur.
Small sphincterotomy and balloon sphincteroplasty for extraction of a common bile duct stone in a patient with juxtapapillary diverticulum
Duodenal diverticula have a prevalence of 9 to 32%. Usually, they are within 2cm of the major duodenal papilla and for that are called juxtapapillary diverticula. They are acquired and their incidence increases with age. Biliary and pancreatic disease is often associated with juxtapapillary diverticula, in particular common bile duct stones. They are directly associated with the outcome of Endoscopic Retrograde Cholangio-Pancreatography (due to the complexity of cannulation) and with an increased rate of complications, in particular bleeding. Various techniques are described to increase the success rate, such as clip-assisted biliary cannulation, endoscopic ultrasound-guided bile duct access, main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. The success rate, independently of these techniques, varies from 61% to 95%.
In this video, we show a case of a patient with angiocholitis secondary to choledocholithiasis, and several cardiovascular co-morbidities, having the papilla of Vater on the edge of a diverticulum. A small sphincterotomy was performed as shown and then bleeding risk was evaluated (the patient being on anticoagulants) and because of the important size of the impacted stone, a sphincteroplasty with dilatation of the papilla with a balloon expanded to 15mm was performed, along with stone extraction using a Dormia basket.
The patient was discharged on postoperative day 2 with normal liver function tests and no inflammation.
Gf Donatelli, C Callari, S Perretta, B Dallemagne
Surgical intervention
9 years ago
1322 views
19 likes
0 comments
05:08
Small sphincterotomy and balloon sphincteroplasty for extraction of a common bile duct stone in a patient with juxtapapillary diverticulum
Duodenal diverticula have a prevalence of 9 to 32%. Usually, they are within 2cm of the major duodenal papilla and for that are called juxtapapillary diverticula. They are acquired and their incidence increases with age. Biliary and pancreatic disease is often associated with juxtapapillary diverticula, in particular common bile duct stones. They are directly associated with the outcome of Endoscopic Retrograde Cholangio-Pancreatography (due to the complexity of cannulation) and with an increased rate of complications, in particular bleeding. Various techniques are described to increase the success rate, such as clip-assisted biliary cannulation, endoscopic ultrasound-guided bile duct access, main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. The success rate, independently of these techniques, varies from 61% to 95%.
In this video, we show a case of a patient with angiocholitis secondary to choledocholithiasis, and several cardiovascular co-morbidities, having the papilla of Vater on the edge of a diverticulum. A small sphincterotomy was performed as shown and then bleeding risk was evaluated (the patient being on anticoagulants) and because of the important size of the impacted stone, a sphincteroplasty with dilatation of the papilla with a balloon expanded to 15mm was performed, along with stone extraction using a Dormia basket.
The patient was discharged on postoperative day 2 with normal liver function tests and no inflammation.
Emergency endoscopic removal of intragastric balloon for hematemesis and melena
The BioEnterics® Intragastric Balloon (BIB®) System has been developed as a temporary aid to achieve weight loss in obese people that are 40% or more above their optimal weight, in patients who have had unsatisfactory results in their treatment of morbid obesity despite being cared for by a multidisciplinary team, and in superobese patients for whom surgery is often associated with high risks. The BIB® reduces the volume of the stomach and leads to a premature feeling of satiety. The placement and removal of the BIB® is an interventional endoscopic procedure and the balloon is designed to float freely inside the stomach; its size can be changed during the placement.
The technique has absolute contraindications such as voluminous hiatus hernia, abnormalities of the pharynx and esophagus, esophageal varicose veins, use of anti-inflammatory or anti-coagulant drugs, pregnancy and psychiatric disorders. Relative contraindications are esophagitis, ulceration and acute lesions of the gastric mucous membrane. The complications of the BIB® are related to the endoscopic method itself, to sedation and perforation, to its prolonged contact with the mucous membrane and its migration, which may result in esophageal or intestinal obstruction (1). The patients must be clinically supervised during the BIB® placement. Complications and symptoms, such as esophageal injury and vomiting due to BIB® slippage must be described to the patient, along with the possibility that the BIB® may require early endoscopic removal. Since the BIB® works as an artificial bezoar, the patients usually show a maximal reduction in ingestion around the fourth week, and return to normal after 12 weeks.

(1) Mathus-Vliegen EMH. Efficacy of bioenterics intragastric balloon treatment in a prospective 2 years follow-up study. Presented at the Eighth European Congress on Obesity; 1997 Aug. Dublin, Ireland: European Congress on Obesity, 1997.
Gf Donatelli, C Callari, S Perretta, B Dallemagne
Surgical intervention
9 years ago
2644 views
14 likes
0 comments
03:36
Emergency endoscopic removal of intragastric balloon for hematemesis and melena
The BioEnterics® Intragastric Balloon (BIB®) System has been developed as a temporary aid to achieve weight loss in obese people that are 40% or more above their optimal weight, in patients who have had unsatisfactory results in their treatment of morbid obesity despite being cared for by a multidisciplinary team, and in superobese patients for whom surgery is often associated with high risks. The BIB® reduces the volume of the stomach and leads to a premature feeling of satiety. The placement and removal of the BIB® is an interventional endoscopic procedure and the balloon is designed to float freely inside the stomach; its size can be changed during the placement.
The technique has absolute contraindications such as voluminous hiatus hernia, abnormalities of the pharynx and esophagus, esophageal varicose veins, use of anti-inflammatory or anti-coagulant drugs, pregnancy and psychiatric disorders. Relative contraindications are esophagitis, ulceration and acute lesions of the gastric mucous membrane. The complications of the BIB® are related to the endoscopic method itself, to sedation and perforation, to its prolonged contact with the mucous membrane and its migration, which may result in esophageal or intestinal obstruction (1). The patients must be clinically supervised during the BIB® placement. Complications and symptoms, such as esophageal injury and vomiting due to BIB® slippage must be described to the patient, along with the possibility that the BIB® may require early endoscopic removal. Since the BIB® works as an artificial bezoar, the patients usually show a maximal reduction in ingestion around the fourth week, and return to normal after 12 weeks.

(1) Mathus-Vliegen EMH. Efficacy of bioenterics intragastric balloon treatment in a prospective 2 years follow-up study. Presented at the Eighth European Congress on Obesity; 1997 Aug. Dublin, Ireland: European Congress on Obesity, 1997.
Endoscopic palliative therapy of an obstructing rectal cancer
Fifteen per cent of rectal cancers are unresectable because of local extension or metastasis.
Endoscopic palliative treatments have been described to avoid surgical palliative procedures (ileostomy, colostomy), which inevitably affect the patient's quality of life.
Endoscopic electrocoagulation, laser therapy and cryotherapy have been used for this purpose, but they need multiple therapeutic sessions: these have a high cost and cause patient discomfort.
Permanent stenting with Self Expanding Metal Stents (SEMS) has been increasingly used for the palliative treatment of obstructing gastrointestinal tumors.
This is the case of a 74-year-old man with an adenocarcinoma of the rectum, T4 N+ M+, that was admitted to our surgical department with sub-occlusion and rectal bleeding.
Under endoscopic-fluoroscopic control, a SEMS was delivered with no complications and the patient was discharged the day after. He was scheduled for a palliative chemotherapy.
Endoscopic stent introduction is a safe palliative procedure performed to improve the quality of life of patients with inoperable tumors of the rectum.
Gf Donatelli, P Ruiz Rodriguez, D Coumaros
Surgical intervention
9 years ago
2406 views
12 likes
0 comments
02:30
Endoscopic palliative therapy of an obstructing rectal cancer
Fifteen per cent of rectal cancers are unresectable because of local extension or metastasis.
Endoscopic palliative treatments have been described to avoid surgical palliative procedures (ileostomy, colostomy), which inevitably affect the patient's quality of life.
Endoscopic electrocoagulation, laser therapy and cryotherapy have been used for this purpose, but they need multiple therapeutic sessions: these have a high cost and cause patient discomfort.
Permanent stenting with Self Expanding Metal Stents (SEMS) has been increasingly used for the palliative treatment of obstructing gastrointestinal tumors.
This is the case of a 74-year-old man with an adenocarcinoma of the rectum, T4 N+ M+, that was admitted to our surgical department with sub-occlusion and rectal bleeding.
Under endoscopic-fluoroscopic control, a SEMS was delivered with no complications and the patient was discharged the day after. He was scheduled for a palliative chemotherapy.
Endoscopic stent introduction is a safe palliative procedure performed to improve the quality of life of patients with inoperable tumors of the rectum.
Endoscopic metal stenting of common bile duct for unresectable pancreatic cancer
Obstructive jaundice occurs in many patients with unresectable pancreatic cancer.
Endoscopic therapy is the best palliative option for inoperable pancreatic cancers, either for the treatment of a potential duodenal stenosis or, in the majority of cases, for the treatment of the associated jaundice.
Metal stents are preferable to plastic stents in patients who have a life expectancy of more than 3 months. The obstruction of the common bile duct is due to cancer of the head of the pancreas that compresses the biliary tree. However, in a few cases, the mucosa of the ampulla is also involved with malignancy from the adjacent pancreas.
We present the case of two patients with unresectable pancreatic cancer, obstructive jaundice and pruritus, in which the drainage of the common bile duct was achieved with an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with insertion of an uncovered metal stent (Wallflex® type) with subsequent relief of the jaundice.
Endoscopic drainage of the common bile duct for obstructive jaundice for unresectable pancreatic cancer is the preferred palliative approach in this type of patient.
Gf Donatelli, M Gualtierotti, D Coumaros
Surgical intervention
9 years ago
2370 views
7 likes
0 comments
04:28
Endoscopic metal stenting of common bile duct for unresectable pancreatic cancer
Obstructive jaundice occurs in many patients with unresectable pancreatic cancer.
Endoscopic therapy is the best palliative option for inoperable pancreatic cancers, either for the treatment of a potential duodenal stenosis or, in the majority of cases, for the treatment of the associated jaundice.
Metal stents are preferable to plastic stents in patients who have a life expectancy of more than 3 months. The obstruction of the common bile duct is due to cancer of the head of the pancreas that compresses the biliary tree. However, in a few cases, the mucosa of the ampulla is also involved with malignancy from the adjacent pancreas.
We present the case of two patients with unresectable pancreatic cancer, obstructive jaundice and pruritus, in which the drainage of the common bile duct was achieved with an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with insertion of an uncovered metal stent (Wallflex® type) with subsequent relief of the jaundice.
Endoscopic drainage of the common bile duct for obstructive jaundice for unresectable pancreatic cancer is the preferred palliative approach in this type of patient.
Endoscopic treatment of esophagojejunostomy dehiscence after total gastrectomy with a fully covered self-expandable metallic stent
The most frequent complications after upper GI surgery are leaks and stenosis. These complications are associated with significant morbidity and mortality rates.
Conservative treatments such as Self-Expanding Metal Stents (SEMS) and balloon dilatation have been described for the treatment of these complications, but stay controversial yet.
We report a case of a 66-year-old woman who underwent a total gastrectomy for a neuro-endocrine tumor that developed an anastomotic dehiscence six days after surgery, successfully treated with a covered SEMS. The stent was well-tolerated and left in place for two weeks. Its ablation confirmed through endoscopic and enhanced X-ray upper series the development of a granulation tissue, along with epithelial proliferation, enough to produce a perfectly closed and healing anastomotic defect. No further surgery was required; oral feeding was started and has been well-tolerated and the patient was soon discharged.
In this case where the use of surgery seemed inevitable and not risk-free, the placement of a removable SEMS was demonstrated to be a safe and efficient technique.
Gf Donatelli, M Gualtierotti, D Coumaros, J Marescaux
Surgical intervention
10 years ago
1548 views
29 likes
0 comments
04:57
Endoscopic treatment of esophagojejunostomy dehiscence after total gastrectomy with a fully covered self-expandable metallic stent
The most frequent complications after upper GI surgery are leaks and stenosis. These complications are associated with significant morbidity and mortality rates.
Conservative treatments such as Self-Expanding Metal Stents (SEMS) and balloon dilatation have been described for the treatment of these complications, but stay controversial yet.
We report a case of a 66-year-old woman who underwent a total gastrectomy for a neuro-endocrine tumor that developed an anastomotic dehiscence six days after surgery, successfully treated with a covered SEMS. The stent was well-tolerated and left in place for two weeks. Its ablation confirmed through endoscopic and enhanced X-ray upper series the development of a granulation tissue, along with epithelial proliferation, enough to produce a perfectly closed and healing anastomotic defect. No further surgery was required; oral feeding was started and has been well-tolerated and the patient was soon discharged.
In this case where the use of surgery seemed inevitable and not risk-free, the placement of a removable SEMS was demonstrated to be a safe and efficient technique.
Transvaginal hybrid sleeve gastrectomy in a patient with a BMI of 40: live surgery during a NOTES course
Laparoscopic sleeve gastrectomy is a relatively new procedure, which is gaining popularity for the treatment of morbid obesity. In this live video demonstration from the March 2009 NOTES Advanced Course at IRCAD in Strasbourg, Dr. Michel Vix performs a hybrid natural orifice transluminal endoscopic sleeve gastrectomy using the vagina as the natural orifice and only two operative 5mm ports. It is a very interesting video demonstration showing that sleeve gastrectomy for the treatment of morbid obesity is feasible and safe in selected patients using the hybrid transvaginal mini-laparoscopic-assisted natural orifice surgery.
M Vix, B Dallemagne, D Coumaros, Gf Donatelli
Surgical intervention
10 years ago
427 views
9 likes
0 comments
15:54
Transvaginal hybrid sleeve gastrectomy in a patient with a BMI of 40: live surgery during a NOTES course
Laparoscopic sleeve gastrectomy is a relatively new procedure, which is gaining popularity for the treatment of morbid obesity. In this live video demonstration from the March 2009 NOTES Advanced Course at IRCAD in Strasbourg, Dr. Michel Vix performs a hybrid natural orifice transluminal endoscopic sleeve gastrectomy using the vagina as the natural orifice and only two operative 5mm ports. It is a very interesting video demonstration showing that sleeve gastrectomy for the treatment of morbid obesity is feasible and safe in selected patients using the hybrid transvaginal mini-laparoscopic-assisted natural orifice surgery.