Gastric cancer is the second leading cause of cancer related death in the world. In United States, gastric polyps are found in approximately 6% of upper endoscopy. The incidence of gastric polyps increased with widespread use of esophagogastroduodenoscopy and more liberal use of proton pump inhibitors. They are usually asymptomatic, but infrequently cause symptoms of bleeding, pain and gastric outlet obstruction. It is important to distinguish premalignant conditions and mimickers of malignancy. Helicobacter pylori eradication therapy leads to regression of hyperplastic polyps but it is not clear for adenoma. Endoscopy plays key role not only in diagnosis but also in surveillance. With narrow band imaging and chromo endoscopy, we are much better today in detecting and discerning these. Also, with endoscopic mucosal resection and endoscopic submucosal dissection, we can manage these better. In this review article we will discuss the various diagnostic tools and therapeutic options for hyperplastic polyp, fundic gland polyp, gastrointestinal stromal tumor, adenoma, neuroendocrine tumor, linitis plastica, and intestinal metaplasia.
Adenoma ; Carcinoid Tumor ; Diagnosis ; Endoscopy ; Endoscopy, Digestive System ; Endosonography ; Gastric Outlet Obstruction ; Gastrointestinal Stromal Tumors ; Helicobacter pylori ; Hemorrhage ; Incidence ; Linitis Plastica ; Metaplasia ; Narrow Band Imaging ; Neuroendocrine Tumors ; Polyps* ; Proton Pump Inhibitors ; Stomach Neoplasms ; United States

Postsurgical leaks are a major complication with significant mobidity and mortality. Conventional conservative and surgical approaches are highly morbid with limited success. Over the last decade several endoscopic techniques have proved effective with a favorable safety profile. Nevertheless, most data still come from retrospective series, and many studies included heterogenous patient groups pooling complex surgical leaks with minor endoscopic perforations. This review focuses on the endoscopic management of the more difficult postsurgical leaks. Stents and over-the-scope clips are currently the key endoscopic techniques for leak closure, but emerging techniques such as vacuum sponge therapy and endoscopic internal drainage have proved to be at least as effective. The current trend is to use these different techniques interchangeably or simultaneously rather than assuming a single standardized approach.
Anastomotic Leak ; Drainage ; Esophageal Fistula ; Gastric Fistula ; Humans ; Mortality ; Porifera ; Retrospective Studies ; Self Expandable Metallic Stents ; Stents ; Vacuum

Gastric cancer remained second commonest cancer worldwide. The diagnosis of early gastric cancer (EGC) is increasing in Japan and South Korea resulting in better oncological outcomes. Endoscopic resection (ER) is safe and effective treatment for EGC with minimal risk of lymph node metastasis. The oncological clearance of ER for EGC in expanded criteria remains controversial. Several retrospective studies showed that endoscopic submucosal dissection (ESD) achieved minimal local recurrence and excellent survival for EGC in expanded indications. With an increasing trend of cancer occuring in the aging population, ER will play a major role in treatment of EGC among elderly who usually have multiple comorbidities. Salvage gastrectomy is generally recommended for those with non-curative ESD, while further researches should be conducted to refine the risks of nodal metastasis for various submucosal EGCs. Endoscopic surveillance is recommended for long term follow-up of patients after curative ESD as the risk of metachronous cancer is significant. Eradication of Helicobacter pylori is generally recommended for EGC treated by ER with a view to reduce the risk of metachronous tumor.
Aged ; Aging ; Comorbidity ; Diagnosis ; Follow-Up Studies ; Gastrectomy ; Helicobacter pylori ; Humans ; Japan ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*

Gastrointestinal perforations, leaks and fistulas may complicate endoscopic and surgical procedures. Surgical repair is associated with significant morbidity. Therapeutic endoscopic tools and techniques have included the application of tissue sealants, clip closure, and stent placement. Endoscopic suturing is a rapidly evolving minimally invasive technique. The OverStitchTM (Apollo Endosurgery, USA) is currently the only available endoscopic suturing system. Although technically more difficult than clip closure, endoscopic suturing allows closure of larger defects. In some settings, outcomes similar to surgical management with less morbidity may be achieved. This review describes the OverStitchTM endoscopic suturing system and the published literature regarding its use for perforations, leaks and fistulas.
Fistula* ; Intestinal Perforation* ; Stents

SUMMARY OF EVENT: Pneumoderma, mediastinal emphysema, and bilateral pneumothorax were developed in the patient who had undergone transesophageal endoscopic ultrasonography-guided rendezvous technique. Chest drainage was performed immediately. TEACHING POINT: Transesophageal approach carries the potential risks of severe complications such as mediastinal emphysema, mediastinitis, and pneumothorax. To prevent puncturing through the esophagus, clipping the esophagogastric junction using a forward-viewing scope before procedure is very useful. In cases of inadvertent transesophageal puncture, devices other than the needle should not be passed through the site.
Drainage* ; Endosonography ; Esophagogastric Junction ; Esophagus ; Humans ; Mediastinal Emphysema ; Mediastinitis ; Needles ; Pneumothorax ; Punctures ; Thorax

Endoscopic retrograde cholangiopancreatography (ERCP) in a surgically altered anatomy is a technically challenging undertaking with variable success and adverse event rates. There are several potential challenges to successfully perform an ERCP in patients with surgically altered anatomy such as identification of afferent limb, accessing and visualization of the papilla, and selective cannulation of the biliary and pancreatic ducts from altered orientation of the papilla. Several strategies to improve the success rate have been recommended by various endoscopy experts. In this review, we discussed the published literature involving various ERCP techniques described for surgically altered anatomies.
Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Endoscopy ; Extremities ; Gastric Bypass ; Humans ; Mortuary Practice ; Pancreatic Ducts ; Pancreaticoduodenectomy

Postoperative bilioenteric anastomotic strictures are encountered in a significant number of patients after primary biliary repair, hepatopancreaticobiliary tumor resection, and liver transplantation. Due to difficulties with repeat surgery and endoscopic access, percutaneous dilation has become the accepted treatment in these cases. While the overall paradigm of percutaneous access, balloon dilation, and catheter stenting remains consistent, institutional protocols differ in several technical variables including balloon sizes, inflation techniques, catheter sizing, and overall time course of treatment, amongst others. The current review aims to discuss various treatment protocols and their relative efficacy, as well as touch on emerging techniques.
Biliary Tract ; Catheters ; Clinical Protocols ; Constriction, Pathologic* ; Humans ; Inflation, Economic ; Liver Transplantation ; Radiology, Interventional ; Reoperation ; Stents

This review highlights new developments in the field of endoscopic ultrasound (EUS)-guided diagnosis and therapy of pancreatic cystic neoplasms. Studies pertinent to pancreatic cyst diagnosis by morphology, namely diagnostic accuracies of various criteria such as pancreatic cyst size, pancreatic duct size, mural nodules and use of EUS contrast agent are discussed. Tissue acquisition during EUS using a novel brush for cytology as well as microforceps is explored further. The role of multiple emerging molecular markers such as CEA, BRAF, KRAS, and GNAS, to name a few, is covered in detail. Recent developments relating to the utility of micro-RNAs in the analysis of cyst fluid is explored. Needle based confocal laser endomicroscopy for pancreatic cyst imaging is a recent development, and findings from recent trials are discussed. Furthermore, recent data regarding the role of ablative therapies using alcohol, paclitaxel and radiofrequency ablation of cyst is covered. Also, given the multiplicity of guidelines regarding management of pancreatic cystic neoplasms, we discuss the merits and shortcoming of these guidelines.
Biomarkers ; Catheter Ablation ; Cyst Fluid ; Diagnosis* ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Needles ; Paclitaxel ; Pancreatic Cyst* ; Pancreatic Ducts ; Pancreatic Neoplasms ; Ultrasonography

Postoperative complications from gastrointestinal surgery can be associated with significant morbidity, and mortality especially if repeat surgery is needed to address these complications. There are wide array of endoscopic interventions and tools available for management of these complications using minimally invasive methods thus decreasing length of hospitalization, morbidity and leading to better patient outcomes. With the advent new tools like Overstitch device, Over the Scope Clip, fibrin glue, etc., these complications can be managed successfully with minimal morbidity. We provide an indepth discussion about available endoscopic options and their application in various scenarios in our article. Endoscopist should be familiar with these complications and endoscopic tools to promote use of these tools and techniques to achieve successful management of these complex conditions.
Adhesives ; Anastomotic Leak ; Fibrin Tissue Adhesive ; Fistula* ; Hospitalization ; Humans ; Mortality ; Postoperative Complications ; Reoperation

Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.
Cholangiopancreatography, Endoscopic Retrograde* ; Hemorrhage ; Intestinal Perforation ; Pancreatitis ; Risk Factors ; Risk Reduction Behavior