Advanced Endoscopy Fellows Program | September 2022-Chahal

Chahal_Interventional EUS

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This document discusses various topics related to advanced endoscopy procedures, specifically focusing on interventions for patients with specific medical histories and conditions.<br /><br />The case presentation involves a 61-year-old man with a history of gastric bypass surgery, bowel perforation, urothelial cancer, rheumatoid arthritis, and chronic kidney disease. The document then explores the best next step in managing his symptoms, discussing options such as laparoscopy-assisted ERCP, EUS-directed ERCP, biliary access enteroscopy (BAE), and other techniques.<br /><br />The document also discusses the use of the EDGE procedure for patients with a history of gastric bypass surgery and gastrogastric fistula. It compares different approaches and factors associated with persistent fistula, adverse events, and management of unexpected situations.<br /><br />In relation to acute cholecystitis, the document provides an overview of the management evolution over time and highlights the use of EUS-guided gallbladder drainage. It discusses the advantages, disadvantages, and indications for this procedure, as well as comparative data and follow-up outcomes.<br /><br />The conclusion emphasizes the use of advanced endoscopy, specifically intraoperative endoscopic ultrasound (iEUS), as an alternative to traditional surgical approaches. However, it notes the need for further research and FDA approval for some techniques.

Keywords

advanced endoscopy procedures

interventions

patients

medical histories

laparoscopy-assisted ERCP

EUS-directed ERCP

biliary access enteroscopy

EDGE procedure

acute cholecystitis

iEUS