ASGE Esophagology General GI Practice Virtual Program (LIVE Virtual) | April 2021-Case Discussion 4 - Managing Esophageal Complications

Video Transcription

Video Summary

In the video, Dr. Usma Siddiqui discusses the importance of recognizing and managing complications that can occur during endoscopy procedures. She presents a case where a patient with a Schatzki's ring experiences significant bleeding during a routine dilation procedure. Dr. Siddiqui poses the question of whether to send the patient to recovery or perform further investigation. The panel agrees that further examination is necessary to determine the cause of the bleeding. The endoscopic view shows a large perforation in the esophagus, and the panel discusses the surrounding mucosa and possible treatment options. The consensus is to attempt endoscopic closure, with various techniques being suggested such as through-the-scope clips or suturing. The panel also discusses the need for antibiotics, nutritional supplementation, and follow-up imaging after the procedure. In another case, Dr. Siddiqui presents a patient with Barrett's esophagus and asks the panel what the next steps should be. The consensus is to repeat the endoscopy and carefully examine the Barrett segment for any nodular areas. Various advanced imaging techniques are suggested, such as high-definition white light, narrowband imaging, and endomicroscopy. The panel recommends a targeted biopsy and reviewing the initial histology. The video concludes with a case of post-radiofrequency ablation (RFA) stricture, which is treated with gentle balloon dilation. The patient later develops hematemesis, which is successfully treated using a coag grasper to address a bleeding vessel.

Asset Subtitle

Panel: Irving Waxman, Mouen Khashab, Peter Draganov, Amitabh Chak, Shivangi Kothari, Vani Konda

Keywords

endoscopy complications

Schatzki's ring

esophageal perforation

endoscopic closure techniques

Barrett's esophagus management

advanced imaging techniques

post-RFA stricture