Endoscopic resection of large pedunculated colonic polyps using endoloop three case reports and review of the literature

Endoscopic polypectomy is now an established procedure for the resection of colorectal polyps. One of the serious complications associated with colonoscopic polypectomy is hemorrhage. Several factors appear to be associated with increased risk of hemorrhage including patient age and colorectal polyp size, location, and morphology [thick stalk or sessile]. In particular, resection of large polyps is associated with a higher risk of serious complications. Bleeding most often occurs within the first 24 hours. More than 95% of cases of bleeding can be treated endoscopically by epinephrine injection, heater probe, or band ligation, alone or in combination. Several methods have been proposed for the prevention of hemorrhage after polypectomy. The most interesting approach is the use of a detachable snare [Endoloop] which allows endoscopic ligation of the stalk of a large, pedunculated polyp. In order to avoid the more severe consequences of bleeding, we use a detachable snare in two patients with a pedunculated polyp with a large head and stalk [> 2 cm]. In a third patient receiving anticoagulant, a detachable snare was chosen to safely and completely remove a large pedunculated polyp > 1.5 cm. In conclusion, colonoscopic polypectomy with Endoloop is safer than conventional polypectomy alone for resection of large, pedunculated polyps, especially in patients with liver disease, coagulopathy and receiving anticoagulant

[Endosonography-guided drainage of a pancreatic pseudocyst. Case report and review of the literature]

Surgery for pancreatic pseudocyst [PP] is becoming an infrequent-therapeutic option with advances in non-surgical drainage procedures. Actually, endoscopic drainage of PPs has become the preferable treatment for symptomatic PPs. It is indicated when a mature pseudocyst is bulging into the wall of the stomach or the duodenum. The risk of perforation and bleeding is increased when no obvious bulge is visible at endoscopy and when no diagnostic method is used to detect the presence of vascular structures. It seems clear that diagnostic endoscopic ultrasound [EUS] is mandatory before attempted endoscopic drainage because it is the most accurate technique to detect interposed vessels, the distance between pseudocyst and gut lumen [<1 cm] and to distinguish cystic neoplasms from PPs. Now EUS may be used alone for cyst decompression. EUS-directed pseudocyst aspiration and drainage is ideal because of advances in EUS endoscope design with new interventional linear echoendoscope with Doppler and large channel. This technique will completely replace the current standard approach of diagnostic EUS with a radial scan endoscope followed by endoscopic drainage with a side-viewing endoscope. We report a case of pancreatic pseudocyst drainage completely guided by endoscopic ultrasound and perform a literature review

Traitement endoscopique des lesions de Dieulafoy

Dieulafoy's lesion is a rare and important cause of gastrointestinal hemorrhage. It is a relatively large artery which lies in close proximity to the mucosal surface. Hemorrhage is often torrential and life threatening. Endoscopy is the most sensitive diagnostic test. Many reports described successful hemostasis utilizing a variety of endoscopic modalities in > 95% of cases. We report an upper gastrointestinal hemorrhage in a patient with Dieulafoy lesion treated successfully by injection, and a literature review