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Video Endoscopic Sequence 1 of 32.
Special Case on Reflux Esophagitis.
We consider this clinical case a very special one since we
have perform several technical novelties on diagnostic and
therapeutical endoscopy, which can be seen in these
sequence; many of them have not been found in the medical
literature, therefore we believe to be the originators and
first practitioners of these novelties. One important think
about this case is that it give us a new and useful
experience, opening up to us new and unlimited diagnostic
and therapeutics possibilities.
This 83 year old male patient , who has suffers of
long-standing gastroesophagic reflux disease (GERD).
Presented with esophageal stenosis with complete lumen
obstrution.
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Video Endoscopic Sequence 2 of 32.
The image display the Foley´s Catheter into the stomach
It began has a progressive dysphagia. At first, he was
under care by another gastroenterologist, who after failing
to dilatate the esophagus, referred the patient to surgery,
where he got a Foley's catheter for Percutaneous feeding.
(surgical gastrostomy).
Due to this way of feeding, the patient suffers some
psychological distress. After three moths of having the
catheter, his family decided to look for a different opinion
and came to us, where we offered to practice a balloon
hydrostatic dilatation.
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Video Endoscopic Sequence 3 of 32.
The image as well as the video clip display the thin
endoscope of 5.9 mm, which is passed through the
gastrostomy fistula.
After the esophagus has been dilated, we performed a
retrograde transfistula endoscopy from the wall of the
stomach all the way through the superior esophageal
sphincter.
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Video Endoscopic Sequence 4 of 32.
Retrograde view from trasfistula endoscopy.
The image as well as the video clip display, the gastric
cardias with complete stenosis and fibrin which occluded
completely the esophageal lumen.
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Video Endoscopic Sequence 5 of 32.
Image view of transfitula retrograde endoscopy. The
hydrostatic balloon was inserted by the mouth and
inspected with a magnifying endoscope.
The image and the video clip of esophageal dilation with
hydrostatic balloon.
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Video Endoscopic Sequence 6 of 32.
Hydrostatic Balloon which is dilating the cardias, esophagus view.
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Video Endoscopic Sequence 7 of 32.
The part of the esophagus that was dilated, patient has a hiatal hernia.
The image and the video clip was obtained from the gastric
camera with endoscope introduced by the fistula of
gastrostomy.
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Video Endoscopic Sequence 8 of 32.
Another image and video clip of the fistula of gastrostomy
where was introduced the endoscope which passed
throughout the esophagus and inspected by the mouth.
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Video Endoscopic Sequence 9 of 32.
Superior Esophagic Sphincter.
Technical Novelty.
Observed through trans-fistula-gastrostomy retrograde
endoscopy.
The endoscope was advanced to overcome the sphincter
observing the nasopharynx then passing by the mouth
towards the outside.
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Video Endoscopic Sequence 10 of 32.
Nasopharynx.
Observed through trans-fistula-gastrostomy retrograde
endoscopy.
We passed it from the mouth right to the back of the nose.
After observing the nasopharynx, the endoscope was
passed through the mouth.
This image and video clip is not usually observed in normal
endoscopic conditions.
With this possibility give us, an unlimited therapeutical
approach alone or together with the otorhinolaryngologist.
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Video Endoscopic Sequence 11 of 32.
Now the endoscope is seen advanced throughout the mouth
Personally, I had always wanted to perform an endoscopy
in retroflexion maneuver in the esophagus and to take out
the endoscope per mouth , but I was afraid of causing a
spasm of the larynx.
These retroflexion maneuvers are sometimes very
important.
We can observe some of them in this atlas:
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Video Endoscopic Sequence 12 of 32.
The flexibility of the thin endoscope is observed.
Download the video clip by clicking on the image.
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Video Endoscopic Sequence 13 of 32.
The endoscope was introduce through the nostrils
observing the oropharynx
Then we have performed another technical novelty, a
retrograde maneuver, from the Gastrostomy- fistula to the
superior esophageal sphincter, the endoscope was
introduce through the nostrils observing the oropharynx;
we have introduced another endoscope into the esophagus.
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Video Endoscopic Sequence 14 of 32.
Withdrawal of the endoscope.
In this video clip it can be observed the return of the thin
endoscope, followed by an magnifying endoscope.
In order to perform a therapeutical approach, we had
the idea of using two endoscopes: one from the fistula and
the other from the mouth, one following the other, facing
each other.
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Video Endoscopic Sequence 15 of 32.
The thin endoscope is withdrawn from the route
trans- fistula and is observed with the second endoscope.
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Video Endoscopic Sequence 16 of 32.
Image obtain with other endoscope via trans-fistula.
We observe now the other endoscope, the thicker one,
which was introduced by the mouth.
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Video Endoscopic Sequence 17 of 32.
Intraluminal “Face to Face Endoscopes”
In this animation hypothesize the multiple forms in this way
of therapeutic endoscopy that could be used through two
“face to face endoscopes”. Using the channels of biopsies
can be combined different limitless therapeutic resources.
Download the animation by clicking on the image.
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Video Endoscopic Sequence 18 of 32.
An over-tube was placed to be able to pass our rigid and maleables clamps.
Now we are ready to perform another technical novelty.
A Trans-Gastric-Trasfistula post Gastrostomy, Retrograde
suturing of the cardias.(Retrograde Gastroplicature).
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Video Endoscopic Sequence 19 of 32.
A semicircular surgical needle with nylon thread is
introduced through the over-tube helped with an object
specially designed of malleable consistency with a magnet
in the tip.
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Video Endoscopic Sequence 20 of 32.
The passage of the semicircular needle with its respective
nylon is observed, also are observed wires in form of
spirals of the over-tube.
Endoscopic image obtained from the gastric camera by the
endoscope inserted through the gastrostomy fistula.
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Video Endoscopic Sequence 21 of 32.
The malleable instrument that it contains a magnet it helps
the passage of the semicircular surgical needle through the
over-tube.
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Video Endoscopic Sequence 22 of 32.
A modified laparoscopic needle holder is observed.
Due to doubles between the over-tube and the injuries it
was necessary to replace the malleable instrument by the
needle holder which has better resistance to manipulate
the needle in the passage to the gastric camera.
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Video Endoscopic Sequence 23 of 32.
A modified laparoscopic needle holder.
In the working table a needle holder is observed which
previous was enlarged from 30 cm to 70 cm.
We used this modified laparoscopic needle holder to
perform the stitches.
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Video Endoscopic Sequence 24 of 32.
The neddle holder is introduced throughout the fistula.
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Video Endoscopic Sequence 25 of 32.
We proceeded to perform the stitches and our new
technique.
And with the mouth-esophagus-stomach endoscopy in
retroflexion the procedure is observed.
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Video Endoscopic Sequence 26 of 32.
And by the same maneuver we finished the gastroplicature.
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Video Endoscopic Sequence 27 of 32.
In this video image it is observed the joint of two tissues,
which will be knotted.
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Video Endoscopic Sequence 28 of 32.
The semicircular needle is withdrawn throughout the over-tube.
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Video Endoscopic Sequence 29 of 32.
Withdrawal of the semicircular surgical needle throughout
the mouth.
Due to the protection of the over-tube there is no danger
of injuries that could be caused by the needle.
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Video Endoscopic Sequence 30 of 32.
Flexible Ti-Knot Device.
The flexible Ti-Knot Device will be use to place the
titanium clip throughout 2 treads to perform the knot.
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Video Endoscopic Sequence 31 of 32.
The flexible Ti-Knot Device is being passed to the
over-tube to will perform the knot.
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Video Endoscopic Sequence 32 of 32.
The gastroplicature was finished.
(Retrograde Gastroplicature).
A Trans-Gastric-Trasfistula post Gastrostomy, Retrograde
suturing of the cardias.
The flexible Ti-Knot Device has been placed the titanium
clip performing the knot.
The patient has been stable since that day.
This case opening up to us new and unlimited diagnostic
and therapeutics possibilities to be performed in a near
future with our patients.
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