An Entirely Atypical Presentation of Esophageal Squamous Cell Cancer with Pancreatic and Bone Metastases.

Few cases of solitary pancreatic metastases from esophageal cancer have been reported; however, these previous cases all describe a solid pancreatic mass. We present a unique case of a 67-year-old man with squamous cell carcinoma detected within a pancreatic cystic lesion that was sampled with endoscopic ultrasound-guided fine needle aspiration. Esophagogastroduodenoscopy identified a friable and fungating partially obstructing mass in the distal esophagus with features of fistulization into the lung. Pathology showed esophageal squamous cell cancer. An isolated bone lesion was also biopsied and revealed squamous cell cancer. The patient tolerated oral intake and a multidisciplinary decision was made for palliative care with home hospices given his comorbidities portending poor operative candidacy and overall poor prognosis secondary to multiple sites of metastases from his esophageal squamous cell cancer.

Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis, a novel technique for malignant obstruction: A case report and review of literature.

For patients suffering from both biliary and duodenal obstruction, endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the treatment of choice. ERCP through an already existing duodenal prosthesis is an uncommon procedure and furthermore no studies have reported installing a covered metal stent onto an already existing bare metal stent in the common bile duct (CBD). We describe a rare case of a stent-in-stent dilatation of the CBD through an already existing self-expanding metal stent in the second part of duodenum for the patient presenting with jaundice in setting of biliary and duodenal obstruction from pancreatic adenocarcinoma. The biliary obstruction was relieved with a decrease in bilirubin levels post-stenting.

Off label use of lumen-apposing metal stent for persistent gastro-jejunal anastomotic stricture.

We are reporting a novel "off-label" use of lumen apposing metal stent (LAMS) for management of refractory gastro-jejunal (GJ) anastomotic stricture after Roux-en-y gastric bypass (RYGB). With increasing prevalence of obesity, bariatric surgery is performed more frequently than ever. RYGB is one of the most commonly performed bariatric procedures. GJ anastomotic stricture is a late complication of this procedure. Our patient, seven years after RYGB developed GJ anastomotic ulcer and subsequently a stricture not amendable to repeated pneumatic dilations. Instead of using the conventional fully covered self-expanding metal stent (fcSEMS) we deployed the relatively new LAMS keeping in mind its novel dumbbell shaped design. Our patient's symptoms were controlled successfully and she remained asymptomatic on follow-up. Despite initial approval for pancreatic pseudocyst drainage, LAMS has been used with increased frequency at various locations within gastrointestinal tract including GJ anastomotic strictures. Future randomized control trials are warranted to compare the efficacy of fcSEMS to LAMS.

A Biliobronchial Fistula in a Patient With Hepatocellcular Carcinoma Treated With Chemoembolization Diagnosed by Hepatobiliary Iminodiacetic Acid Scan and Managed by Endoscopic Retrograde Cholangiopancreatography.

A biliobronchial fistula is an abnormal communication between the biliary tract and the bronchial tree. It may be a rare complication after treatment of hepatocellular carcinoma with transcatheter arterial chemoembolization (TACE). We present a case of a 71-year-old man that developed a biliobronchial fistula as a complication of hepatocellular carcinoma treated with TACE. It was successfully diagnosed by hepatobiliary iminodiacetic acid (HIDA) scan and treated with endoscopic retrograde pancreatography.