El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
 This 91-year-old male with adenocarcinoma of the cardias In order to alleviate the malign dysphagia an esophageal stent is placed without fluroscopy, a stent's retractable delivery system was used.

Videoendoscopic Sequence 1 of 14.

 This 91-year-old male with adenocarcinoma of the cardias
 In order to alleviate the malign dysphagia an esophageal
 stent is placed without fluroscopy, a stent's retractable
 delivery system was used.
 

 No patient is more unfortunate than those than suffer a
 malignant obstruction of the esophagus, because they die
 of slow starvation” and cannot die with dignity without
 being able to swallow”.

 

 For more endoscopic details, download the video clips
 by clicking on the endoscopic images. Wait to be
 downloaded complete then Press Alt and Enter for full
 screen.

 All endoscopic images shown in this Atlas contain
 video clips. We recommend seeing the video clips in full
 screen mode
.

The Antrum is infiltrated as well as the corpus and fundus an extensive irregular ulceration at the gastric antrum that could think about being lymphoma but the biopsies ruled out.

Videoendoscopic Sequence 2 of 14.

 The Antrum is infiltrated as well as the corpus and fundus
 an extensive irregular ulceration at the gastric antrum that
 could think about being lymphoma but the biopsies
 ruled out.

 

The main lesion is in the gastric fundus that is constricted and ulcerated seen at at retroflexion

Videoendoscopic Sequence 3 of 14.

 The main lesion is in the gastric fundus that is constricted
 and ulcerated seen at at retroflexion.

 

 

The second part of the duodenum observing a peculiar pattern, The yellow patches of mucosa are Intestinal Microvilli alternating with absence of them

Videoendoscopic Sequence 4 of 14.

 The second part of the duodenum observing a peculiar
 pattern,
The yellow patches of mucosa are Intestinal
 Microvilli
alternating with absence of them.

 

Papilla of Vater is observed with different morphology, possibly by compression of carcinonomatosis.

Videoendoscopic Sequence 5 of 14.

 Papilla of Vater is observed with different morphology,
 possibly by compression of carcinonomatosis.

 

 A close up of thePapilla of Vater.

Videoendoscopic Sequence 6 of 14.

 A close up of thePapilla of Vater

Deployed a standard guidewire into the stomach. Then, withdrew the endoscope and repositioned it near the guidewire to visualize the proximal stricture margin.

Videoendoscopic Sequence 71 of 14.

The Beginning of the Procedure

 Deployed a standard guidewire into the stomach. Then,
 withdrew the endoscope and repositioned it near the
 guidewire to visualize the proximal stricture margin.

 

 

Through the guide of Savari, the apparatus to place the Stent it is passed through the oro-pharynx, soon under direct vision with endoscope.

Videoendoscopic Sequence 8 of 14.

 Controlled Release Esophageal Stent System

 Through the guide of Savari, the apparatus to place the
 Stent it is passed through the oro-pharynx, soon under
 direct vision with endoscope.

 Esophageal stent placement under endoscopic
 control alone.

 

The stent was passed across the stricture and the white mark was positioned near the proximal margin using direct visualization. The stent then was released; placement was confirmed by direct visualization.

Videoendoscopic Sequence 9 of 14.

 The stent was passed across the stricture and the white
 mark was positioned near the proximal margin using direct
 visualization. The stent then was released; placement was
 confirmed by direct visualization.

More maneuvers to pass the Stent.

Videoendoscopic Sequence 10 of 14.

More maneuvers to pass the Stent

 During an esophageal stent placement procedure, a tiny
 tube known as a stent is placed at a point of narrowing or
 blockage to open up the esophagus to help the patient
 swallow or drink more easily. These tubes are made out of
 polyester(plastic), nitinol(metal) or hybrid material. Stents
 may be used to treat patients suffering from a refractory
 benign (non-cancerous) or malignant (cancerous) disease.

 

The Evolution stent's retractable delivery system facilitates direct monitoring of the placement progress throughout the procedure with it's “point-of-no-return” indicator, allowing physicians more controlled placement of the stent. With each squeeze of the stent's trigger-based introducer, a proportional length of the stent is deployed or recaptured. The directional button enables seamless switching from deployment to recapture mode and the “point-of-no-return” mark alerts the physician when recapture is no longer available. However, even after this point repositioning is still an option.

Videoendoscopic Sequence 11 of 14.

 The Evolution stent's retractable delivery system
 facilitates direct monitoring of the placement progress
 throughout the procedure with it's “point-of-no-return”
 indicator, allowing physicians more controlled placement
 of the stent. With each squeeze of the stent's
 trigger-based introducer, a proportional length of the stent
 is deployed or recaptured. The directional button enables
 seamless switching from deployment to recapture mode
 and the “point-of-no-return” mark alerts the physician
 when recapture is no longer available. However, even
 after this point repositioning is still an option.

 

The Evolution Stent is designed with dual flanges that secure the stent, potentially reducing the risk of migration or stent movement after placement, thus eliminating the need for repeat procedures. It is also the only esophageal stent with an internal and external silicone coating, designed to resist tumor ingrowth into the stent and enhances the patients' ability to swallow food normally instead of eating through a tube.

Videoendoscopic Sequence 12 of 14.

A 12-cm stent was used for the stricture

 The Evolution Stent is designed with dual flanges that
 secure the stent, potentially reducing the risk of migration
 or stent movement after placement, thus eliminating the
 need for repeat procedures. It is also the only esophageal
 stent with an internal and external silicone coating,
 designed to resist tumor ingrowth into the stent and
 enhances the patients' ability to swallow food normally
 instead of eating through a tube.

 

In this video the deploying of the Stent is observed.

Videoendoscopic Sequence 13 of 14.

Stent with retractable delivery system

In this video the deploying of the Stent is observed

 The esophageal stent maintaining esophageal lumen
 patency in esophageal strictures caused by intrinsic or
 extrinsic tumors.

 

EsophaegalStenx15

Videoendoscopic Sequence 14 of 14.

Final Status of the stent placement

 This technique should not be used in patients with
 complicated anatomy or perforation when safety and
 accuracy likely would be enhanced by fluoroscopy.

 

Endoscopic-placed stent to provide palliation of dysphagia. The patient obtained a significant improvement in the quality of life. Successfully deployed Self-expanding stent in the esophagus under fluroscopy control. This image and the video clip were taken one week after the procedure. Esophageal Z-Stent with dual anti-reflux valve is used to maintain patency of malignant esophageal strictures and to decrease esophageal reflux and aspiration.  Effective method of palliating dysphagia related to stricture caused by malignant esophageal lesions. Esophageal balloon dilation and expandable stent placement are safe, minimally invasive, effective treatments for esophageal malign strictures. These procedures have brought the management of dysphagia due to esophageal strictures into the field of interventional radiology. Esophageal dilation is usually indicated for benign stenoses and is technically successful in more than 90% of cases. Most patients with esophageal carcinoma are not candidates for resection; thus, the main focus of treatment is palliation of malignant dysphagia.

To see the complete endoscopic sequence of this case click here.

 Endoscopic-placed stent to provide palliation of dysphagia.

 The patient obtained a significant improvement in the
 quality of life.

 Successfully deployed Self-expanding stent in the
 esophagus under fluroscopy control.
 This image and the video clip were taken one week after
 the procedure.

 Esophageal Z-Stent with dua anti-reflux valve is used to
 maintain patency of malignant esophageal strictures and
 to decrease esophageal reflux and aspiration.

 Effective method of palliating dysphagia related to stricture
 caused by malignant esophageal lesions.

 Esophageal balloon dilation and expandable stent
 placement are safe, minimally invasive, effective
 treatments for esophageal malign strictures.

 These procedures have brought the management of
 dysphagia due to esophageal strictures into the field of
 interventional radiology. Esophageal dilation is usually
 indicated for benign stenoses and is technically successful
 in more than 90% of cases. Most patients with esophageal
 carcinoma are not candidates for resection; thus, the main
 focus of treatment is palliation of malignant dysphagia.

 

StentOverStent1

Videoendoscopic Sequence 1 of 28.

Distal Esophageal Squamous Cell Carcinoma.

This 62 year-old female, presented with progresive disphagia to solid following to liquids.

 Because the esophagus lacks a serosal covering,
 esophageal carcinoma encounters few anatomic barriers to
 local invasion.

Endoscopic views of an ulcerated mid-esophageal squamous cell carcinoma causing lumenal stenosis are seen in the endoscopic image as well as the video clip.

Videoendoscopic Sequence 2 of 28.

 Endoscopic views of an ulcerated mid-esophageal
 squamous cell carcinoma causing lumenal stenosis are
 seen
in the endoscopic image as well as the video clip.

 Risk factors for esophageal squamous carcinoma include
 mainly smoking and alcoholism in the U.S. In other parts
 of the world dietary factors may play a role. Cancer of the
 esophagus remains a devastating disease because it is
 usually not detected until it has progressed to an advanced
 incurable stage.

 At the time of diagnosis, weight loss and dysphagia are the
 most common symptoms. Dysphagia usually occurs late in
 the course of the disease when the esophageal lumen has
 been narrowed by 50-75%. Less commonly, presenting
 symptoms may be related to local invasion or metastases.

 

Retroflexed image, seen the tumor at the gastric cardias.    Examples of signs and symptoms include stridor, cough, and aspiration pneumonia as the result of erosion into the tracheobronchial tree; hemoptysis or hematemesis resulting from invasion of a mediastinal vessel; left vocal cord paralysis resulting from recurrent laryngeal nerve involvement by tumor or lymph node metastasis; malignant pleural effusion; and diaphragmatic paralysis. Jaundice and bone pain are systemic manifestations of organ metastases.

Videoendoscopic Sequence 3 of 28.

Retroflexed image, seen the tumor at the gastric cardias

 Examples of signs and symptoms include stridor, cough,
 and aspiration pneumonia as the result of erosion into the
 tracheobronchial tree; hemoptysis or hematemesis
 resulting from invasion of a mediastinal vessel; left vocal
 cord paralysis resulting from recurrent laryngeal nerve
 involvement by tumor or lymph node metastasis;
 malignant pleural effusion; and diaphragmatic paralysis.
 Jaundice and bone pain are systemic manifestations of
 organ metastases.

 

The Stent was tried to be applied, and was placed above the tumor. This Stent was tried to be placed without fluroscopy under direct vision. The model of this manufacturer is relatively new, which is applied in a way, like the arms imitating a gun. We were excited when seeing the image of the stent that was being unrolled like a screw, but we didn't notice that we had passed from the zone of security of the stent of where it is possible to be dissuaded before being released. Therefore we had to leave it on top of the tumor and to reprogram, to place another one in a second intention, being placed under direct vision without fluroscopia like it is observed in the sequences of below. We at least gained a good case to place it in this atlas.

Videoendoscopic Sequence 4 of 28.

 Failure to place the first Stent

Stent with retractable delivery system

 The Stent was tried to be applied, and was placed above
 the tumor. This Stent was tried to be placed without
 fluroscopy under direct vision. The model of this
 manufacturer is relatively new, which is applied in a way,
 like the arms imitating a gun. We were excited when
 seeing the image of the stent that was being unrolled like a
 screw, but we didn’t notice that we had passed from the
 zone of security of the stent of where it is possible to be
 dissuaded before being released.
 (
With it's “point-of-no -return”) indicator Therefore we had
 to leave it on top of the tumor and to reprogram, to place
 another one in a second intention, being placed under
 direct vision without fluroscopia like it is observed in the
 sequences of below. We at least gained a good case to
 place it in this atlas.

We used a Stent's retractable delivery system facilitates direct monitoring of the placement progress throughout the procedure with it's “point-of-no-return” indicator, allowing physicians more controlled placement of the stent.

Videoendoscopic Sequence 5 of 28.

Upper portion of stent

 We used a Stent's retractable delivery system facilitates
 direct monitoring of the placement progress throughout the
 procedure with it's “point-of-no-return” indicator, allowing
 physicians more controlled placement of the stent.

It is come to dilate the tumor with a hydrostatic balloon. The  procedure is continued making an ablative therapy with argon plasma. Two weeks later another stent is placed. In this image and video, the first stent placed of the tumor, is observed.

Videoendoscopic Sequence 6 of 28.

 The hydrostatic balloon is used to delated the tumor.

 The procedure is continued performing with an ablative
 therapy with argon plasma. Two weeks later another stent
 is placed to overcome the stenosis caused by the neoplasia.
 In this image and video clip, the first stent is placed
 above of the tumor.

 

The procedure is continued performing ablative therapy with argon plasma.

Videoendoscopic Sequence 7 of 28.

 The procedure is continued performing ablative therapy with argon plasma.

Two weeks later another stent is place. In this image as well as the video clip is observed the first stent placed above of the neoplasia.

Videoendoscopic Sequence 8 of 28.

Two weeks later another stent is place

 In this image as well as the video clip is observed the first
 stent placed above of the neoplasia.

A close up of the tumor. Palliation is directed at reducing esophageal obstruction sufficiently to allow oral intake. Suffering caused by esophageal obstruction can be significant, with salivation and recurrent aspiration. Options include manual dilation procedures (bougienage), orally inserted stents, radiation therapy, laser photocoagulation, and photodynamic therapy. In some cases, cervical esophagostomy with feeding jejunostomy is required.

Videoendoscopic Sequence 9 of 28.

A close up of the tumor

 Palliation is directed at reducing esophageal obstruction
 sufficiently to allow oral intake. Suffering caused by
 esophageal obstruction can be significant, with salivation
 and recurrent aspiration. Options include manual dilation
 procedures (bougienage), orally inserted stents, radiation
 therapy, laser photocoagulation, and photodynamic
 therapy. In some cases, cervical esophagostomy with
 feeding jejunostomy is required.

 

Deployed a standard guidewire into the stomach.

Videoendoscopic Sequence 10 of 28.

 Deployed a standard guidewire into the stomach. Then,
 withdrew the endoscope and repositioned it near the
 guidewire to visualize the proximal stricture margin.

As with dilation, technological advances have driven the increased use of, and indications for, endolumenal stents in the alimentary canal. Expandable stent therapy has virtually supplanted conventional prosthesis placement in the esophagus, given the relative ease of placement and improved safety profi le during insertion. Nevertheless, critical evaluation of this technology suggests that the need for intervention actually may increase after placement of expandable esophageal stents. This reintervention is a direct consequence of stent design: uncovered stents elicit granulation tissue and allow tumor ingrowth, and completely covered prostheses have a penchant for migration. All prostheses have the capability of causing erosion with fi stulization, gastrointestinal bleeding, or occlusion by food bolus.

Videoendoscopic Sequence 11 of 28.

Another image and video clip of the first stent

 As with dilation, technological advances have driven the
 increased use of, and indications for, endolumenal stents
 in the alimentary canal. Expandable stent therapy has
 virtually supplanted conventional prosthesis placement in
 the esophagus, given the relative ease of placement and
 improved safety profi le during insertion. Nevertheless,
 critical evaluation of this technology suggests that the
 need
for intervention actually may increase after
 placement
of expandable esophageal stents. This
 reintervention is a direct consequence of stent design:
 uncovered stents elicit granulation tissue and allow tumor
 ingrowth, and completely covered prostheses have a
 penchant for migration. All prostheses have the capability
 of causing erosion with fi stulization, gastrointestinal
 bleeding, or occlusion by food bolus.

Videoendoscopic Sequence 12 of 28.

Begins to place the second stent

 

StentoverStent10

Videoendoscopic Sequence 13 of 28.

 The procedure with the apparatus to place the stent is being performed delivering the second stent.

I

Taking care of terminal patients with an advanced esophageal cancer is a difficult task, both from a clinical perspective and a psychological one.

Videoendoscopic Sequence 14 of 28.

 Taking care of terminal patients with an advanced
 esophageal cancer is a difficult task, both from a clinical
 perspective and a psychological one.

.

StentOverStent12

Videoendoscopic Sequence 15 of 28.

Controlled Release Esophageal Stent System

The deliver of the second stent is being iniciated

 

StentOverStent12B

Videoendoscopic Sequence 16 of 28

 

StentOverStent13

Videoendoscopic Sequence 17 of 28.

 

The stent got immediately lodged under the inferior gastroesophageal sphincter.

Videoendoscopic Sequence 18 of 28.

 The stent got immediately lodged under the inferior
 gastroesophageal sphincter.

The image as well as the video clip show the distal part of the stent just below of the inferior gastroesophagic sphincter, retroflexed image.

Videoendoscopic Sequence 19 of 28.

 The image as well as the video clip show the distal part of
 the stent just below of the inferior gastroesophageal
 sphincter, r
etroflexed image.

View through the stent

Videoendoscopic Sequence 20 of 28.

View through the stent

View through the stent

Videoendoscopic Sequence 21 of 28.

View through the stent

View through the stent

Videoendoscopic Sequence 22 of 28.

View through the stent

The improvement of the symptoms was remarkable, the patient overcome her dysphagia managing to pass its solid foods without difficulty.-

Videoendoscopic Sequence 23 of 28.

 The improvement of the symptoms was remarkable, the
 patient overcame her dysphagia managing to pass its solid
 foods without difficulty.

 

Videoendoscopic Sequence 24 of 28.

 Esophageal Squamous Cell Carcinoma.

StentOverStent20

Videoendoscopic Sequence 25 of 28.

 

Videoendoscopic Sequence 26 of 28.

 

Videoendoscopic Sequence 27 of 28.

This fragment of the tumor was given off when placing first stent.

 

More image of the fragment

Videoendoscopic Sequence 28 of 28.

More image of the fragment