El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Para esophageal Hernia and Barrett Esophagus. This is the case of a 63 year-old woman that has been suffering of long-standing reflux disease.

Video Endoscopic Sequence 1 of 13.

Paraesophageal Hernia and Barrett Esophagus.

 This is the case of a 63 year-old woman that has been
 suffering of long-standing reflux disease.
Hiatal hernias may be classified into one of four types.Type I (sliding hiatal hernia) in which there is a migration of the esophago-gastric junction above the diaphragm into the thorax is the most common. Type II is a true paraesophageal hernia in which the stomach herniates into the thorax, but the esophago-gastric junction remains fixed in its normal anatomic location below the diaphragm. Type III (mixed paraesophageal hernia) is a combination of a sliding hiatal hernia with some or all of the stomach herniating above the esophago-gastric junction. Type IV are those hiatal hernias which include abdominal viscera and or solid organs within the hernia sac. Rarely, a parahiatal hernia, where gastric herniation occurs through a diaphragmatic defect separate from the hiatus, may be seen.

Video Endoscopic Sequence 2 of 13.

 Hiatal hernias may be classified into one of four types.
 Type I (sliding hiatal hernia) in which there is a migration
 of the esophago-gastric junction above the diaphragm into
 the thorax is the most common. Type II is a true
 paraesophageal hernia in which the stomach herniates into
 the thorax, but the esophago-gastric junction remains fixed
 in its normal anatomic location below the diaphragm. Type
 III (mixed paraesophageal hernia) is a combination of a
 sliding hiatal hernia with some or all of the stomach
 herniating above the esophago-gastric junction. Type IV
 are those hiatal hernias which include abdominal viscera
 and/or solid organs within the hernia sac. Rarely, a
 parahiatal hernia, where gastric herniation occurs through
 a diaphragmatic defect separate from the hiatus, may be
 seen.
Sliding hiatal hernia. The patient has also a complex hernia

Video Endoscopic Sequence 3 of 13.

Sliding hiatal hernia.

The patient has also a complex hiatal hernia
Barrett Esophagus. The Barrett's epithelium is recognizable as salmon colored esophageal mucosa that contrasts with the pearly white appearance of the normal esophageal squamous mucosa. The length of Barrett's epithelium is conventionally measured by subtracting the distance from the incisors to the squamocolumnar junction from the distance to the top of the gastric folds. The gastric folds are apparent here. The squamocolumnar junction is seen here.

Video Endoscopic Sequence 4 of 13.

Barrett Esophagus.

 The Barrett's epithelium is recognizable as salmon colored
 esophageal mucosa that contrasts with the pearly white
 appearance of the normal esophageal squamous mucosa.
 The length of Barrett's epithelium is conventionally
 measured by subtracting the distance from the incisors to
 the squamocolumnar junction from the distance to the top
 of the gastric folds. The gastric folds are apparent here.
 The squamocolumnar junction is seen here.
 

 
Tongues of Barrett's metaplasia.

Video Endoscopic Sequence 5 of 13.

Tongues of Barrett's metaplasia.

 
Inside the Paraesophageal hernia, there are fibers accumulated.

Video Endoscopic Sequence 6 of 13.

Inside the Paraesophageal hernia, there are fibers accumulated.
Endoscopic Ablation of Barrett's esophagus with argon plasma coagulator. Management of Barrett esophagus is still a clinical challenge Although the incidence of cancer appears to be low, occurring in 0.5% of patients with Barrett esophagus.

Video Endoscopic Sequence 7 of 13.

Endoscopic Ablation of Barrett's esophagus with argon plasma coagulator.

 Management of Barrett esophagus is still a clinical
 challenge Although the incidence of cancer appears to be
 low, occurring in 0.5% of patients with Barrett esophagus.
Argon plasma coagulation is one of several techniques used to ablate Barrett's esophagus.

Video Endoscopic Sequence 8 of 13.

Argon plasma coagulation is one of several techniques used to ablate Barrett's esophagus.

 
Endoscopic ablation of Barrett's esophagus using high power setting argon plasma coagulation 90 watts.

Video Endoscopic Sequence 9 of 13.

Endoscopic ablation of Barrett's esophagus using high power setting argon plasma coagulation 90 watts.

 
APC treatment of Barrett's esophagus is simple, efficacious and safe. Reversal of Barrett's mucosa can be achieved by a few endoscopic sessions. But long term follow-up studies on many patients are necessary to establish the frequency of endoscopic surveillance on the basis of recurrence or dysplasia evolution risk, in spite of APC treatment.

Video Endoscopic Sequence 10 of 13.

APC treatment of Barrett's esophagus is simple, efficacious and safe. Reversal of Barrett's mucosa can be achieved by a few endoscopic sessions. But long term follow-up studies on many patients are necessary to establish the frequency of endoscopic surveillance on the basis of recurrence or dysplasia evolution risk, in spite of APC treatment.

 
APC is a technique that delivers controlled monopolar electrocoagulation via a stream of ionized argon gas ignited by a high voltage discharged at the tip of a specialized flexible probe. It is a noncontact ablative method with a predetermined depth of injury (approximately 2 mm) that is most often used for coagulation of bleeding surfacelesions such as arteriovenous malformations.

Video Endoscopic Sequence 11 of 13.

 APC is a technique that delivers controlled monopolar
 electrocoagulation via a stream of ionized argon gas ignited
 by a high voltage discharged at the tip of a specialized
 flexible probe. It is a noncontact ablative method with a
 predetermined depth of injury (approximately 2 mm) that is
 most often used for coagulation of bleeding surface lesions
 such as arteriovenous malformations.
Ablative therapy The goal of ablative therapy is to destroy the Barrett epithelium to a sufficient depth to eliminate the intestinal metaplasia and allow regrowth of squamous epithelium. A number of modalities have been tried, e.g. photodynamic therapy, argon plasma coagulation, multipolar electrocoagulation and various forms of lasers. There is no direct evidence to suggest that there is a reduction in cancer risk in patients after mucosal ablation therapy. Long term outcomes have been disappointing in terms of relapse after treatment, but this form of treatment is still considered to offer the prospect of developing improved intervention for the future

Video Endoscopic Sequence 12 of 13.

 Ablative therapy. The goal of ablative therapy is to destroy
 the Barrett epithelium to a sufficient depth to eliminate the
 intestinal metaplasia and allow regrowth of squamous
 epithelium. A number of modalities have been tried, e.g.
 photodynamic therapy, argon plasma coagulation,
 multipolar electrocoagulation and various forms of lasers.
 There is no direct evidence to suggest that there is a
 reduction in cancer risk in patients after mucosal ablation
 therapy. Long term outcomes have been disappointing in
 terms of relapse after treatment, but this form of treatment
 is still considered to offer the prospect of developing
 improved intervention for the future.
A follow up endoscopy was performed six months after the APC ablation. Due to the APC ablation the tongues have been shortened, but there is a Barrett epithelium yet, a new session of APC will be programmed.

Video Endoscopic Sequence 13 of 13.

A follow up endoscopy was performed six months after the APC ablation.

 Due to the APC ablation the tongues have been shortened,
 but there is Barrett epithelium yet, a new session of APC
 will be programmed.