Cancer GastricTherapeutic Appoach. El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy

 
Double Primary Cancers. Adenocarcinoma of the cardias and carcinoma epidermoid of the larynx. This 80 year old male, That two years ago presented this adenocarcinoma of the cardias. The patient has a medical record of longstanding gastroesophageal reflux disease and smoking. The image and the video clips display an obstructing adenocarcinoma. The Epidemiology of Esophageal Cancer Has Changed Dramatically During The past Decade. The Incidence of Adenocarcinoma Associated With Barrett's metaplasia Is Rising Dramatically.

Video Endoscopic Sequence 1 of 27.

Double Primary Cancers.

 Adenocarcinoma of the cardias and simultaneous carcinoma
 epidermoid of the larynx.

 This 80 year old male, That two years ago presented this
 adenocarcinoma of the cardias.
 The patient has a medical record of longstanding
 gastroesophageal reflux disease and smoking. The image
 and the video clips display an obstructing adenocarcinoma.
 
 The Epidemiology of Esophageal Cancer Has Changed
 Dramatically During The past Decade. The Incidence of
 Adenocarcinoma Associated With Barrett's metaplasia Is
 Rising Dramatically.

 For further endoscopic information, download the video clip
 by clicking on the endoscopic image. Wait to be downloaded
 complete then Press Alt and Enter for full screen
 (Windows Media), and Ctrl and 3 for Real player.
 
 All endoscopic images shown in this Atlas contain
 video clips. We recommend seeing the video clips in full
 screen mode.

Squamous cell carcinoma of the larynx. Four months previously, the patient presented with hoarseness. The etiology of oral epidermoide carcinoma is connected to the abusive use of tobacco and alcohol, having been in various studies demonstrated the effect synergetic of these agents, the gastroesophageal reflux disease play role in pathogenesis of the Squamous cell carcinoma of the larynx.

Video Endoscopic Sequence 2 of 27.

Squamous cell carcinoma of the larynx.

 Four months previously, the patient presented with
 hoarseness.

 The etiology of oral epidermoide carcinoma is connected to
 the abusive use of tobacco and alcohol, having been in
 various studies demonstrated the effect synergetic of these
 agents, the gastroesophageal reflux disease play role in
 pathogenesis of the Squamous cell carcinoma of the larynx.
 Double Primary Cancers.
                                           Medline.
Squamous cell carcinoma of the larynx.

Video Endoscopic Sequence 3 of 27.

Squamous cell carcinoma of the larynx.

 
Squamous cell carcinoma of the larynx. We used a regular endoscopy forceps biopsy device to optain the biopsies of the larynx cancer.

Video Endoscopic Sequence 4 of 27.

Squamous cell carcinoma of the larynx.

 We used a regular endoscopy forceps biopsy device to
 optain the biopsies of the larynx cancer.
Obstructing adenocarcinoma of the cardias.Palliative treatment with argon plasma coagulator APC. Esophageal cancer are detected every year. Progressive dysphagia, initially to solids, later to liquids and secretions, is one of the most frequent debilitating complaints. The prognosis is dismal: more than 60% of patients are not operable at the time of diagnosis.

Video Endoscopic Sequence 5 of 27.

Obstructing adenocarcinoma of the cardias.

Palliative treatment with argon plasma coagulator APC.

 Esophageal cancer are detected every year. Progressive
 dysphagia, initially to solids, later to liquids and secretions,
 is one of the most frequent debilitating complaints. The
 prognosis is dismal: more than 60% of patients are not
 operable at the time of diagnosis.
                                          Medline.
Palliative treatment with argon plasma coagulator APC. The image and the video clip shows the APC catheter, The APC probe produces a plasma arc that destroys tissue to a depth of approximately 2 to 3 mm. Palliation is the only realistic therapeutic option for these patients. Available palliative treatment modalities include chemotherapy, radiation therapy, esophageal dilation, multipolar electrocoagulation, laser treatment, injection of sclerosing agents, photodynamic therapy, and esophageal endoprostheses.

Video Endoscopic Sequence 6 of 27.

Debulking of the Tumor.

 Palliative treatment with high power setting of argon
 plasma coagulator APC.

 The image and the video clip shows the APC catheter,
 The APC probe produces a plasma arc that destroys tissue
 to a depth of approximately 2 to 3 mm.

 Palliation is the only realistic therapeutic option for these
 patients. Available palliative treatment modalities include
 chemotherapy, radiation therapy, esophageal dilation,
 multipolar electrocoagulation, laser treatment, injection of
 sclerosing agents, photodynamic therapy, and esophageal
 endoprostheses.
Recanalization of the esophagus. Argon plasma coagulation (APC) is an ablative endoscopic technique. The patient received the therapy by three different days with an interval of four days, After the third treatment we passed to the gastric camera with endoscope of 9.5 mm.

Video Endoscopic Sequence 7 of 27.

 Recanalization of the Esophagus.

 Argon plasma coagulation (APC) is an ablative endoscopic
 technique. The patient received the therapy by four
 different days with an interval of four days, After the third
 treatment we passed to the gastric camera with endoscope
 of 9.5 mm.

Endoscopic Appearance, after one week of the ablative therapy of the tumor.

Video Endoscopic Sequence 8 of 27.

Endoscopic appearance, after one week of the ablative therapy of the tumor.

 Ablative therapy of the tumor for removing voluminous
 masses of tissues and especially for recanalisations of
 stenoses of gastrointestinal tract.

 

 
Several session of ablative therapy was performed in order to overpass the cardias with the endoscope.

Video Endoscopic Sequence 9 of 27.

Several session of ablative therapy was performed in order
to overpass the cardias with the endoscope.

 APC is a noncontact electrocoagulation device that uses
 high-frequency monopolar current conducted to target tissues
 through ionized argon gas (argon plasma). Electrons flow through
 a channel of electrically activated, ionized argon gas from the
 probe electrode to the targeted tissue. Current density on arrival
 at the tissue surface causes coagulation. Coagulation depth is
 dependent on generator power setting, flow rate of the argon gas,
 duration of application, and distance of the probe tip to the
 target tissue.
After four session of high power setting of argon plasma coagulator, we managed to have a suitable opening of the cardia.

Video Endoscopic Sequence 10 of 27.

 Recanalization enabling passage of normal food.

 After four session of high power setting of argon plasma
 coagulator, we managed to have a suitable opening of the
 cardia.

 

 
After the recanalization, We took advantage of introduced the endoscope to the gastric camera and to apply more coagulation to the tumour. The argon arc contacts tissue closest to the electrode allowing for en face or tangential coagulation. With thermal coagulation of tissue, a thin, superficial, electrically insulating zone of desiccation and a steam layer (from the boiling of tissue) result, both contributing to limit carbonization and depth of coagulation. The insulating zone of desiccation produces increased electrical resistance in the treated area. This prompts the current to move to another point on the tissue surface where resistance is lower. However, with prolonged application carbonization, vaporization, and deep tissue injury can occur.

Video Endoscopic Sequence 11 of 27.

 After the recanalization, We took advantage of introduced
 the endoscope to the gastric camera and to apply more
 coagulation to the tumor.

 The argon arc contacts tissue closest to the electrode allowing for
 en face or tangential coagulation. With thermal coagulation of
 tissue, a thin, superficial, electrically insulating zone of desiccation
 and a steam layer (from the boiling of tissue) result, both
 contributing to limit carbonization and depth of coagulation. The
 insulating zone of desiccation produces increased electrical
 resistance in the treated area. This prompts the current to move
 to another point on the tissue surface where resistance is
 lower. However, with prolonged application carbonization,
 vaporization, and deep tissue injury can occur.

Successfully deployed Self-expanding stent. View through the stent. Successfully deployed Self-expanding stent in the esophagus under fluroscopy control. This image and the video clip were taken ten days 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.

Video Endoscopic Sequence 12 of 27.

View through the stent.

 Successfully deployed Self-expanding stent in the
 esophagus under fluroscopy control.
 This image and the video clip were taken ten days 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.
                                          Medline.
Anti-Reflux valves of the stent . This endoscopic image displays Anti-Reflux valves of the stent.

Video Endoscopic Sequence 13 of 27 .

Anti-Reflux Stent

 This endoscopic image displays Anti-Reflux valves of
 the stent.

 Self-expanding metal stents (SEMS) have become accepted
 palliation for inoperable malignant esophageal obstruction.

                                          

                                          Medline.
A follow up Endoscopy four weeks after the stent was placed. The Z-stent consists of a series of stainless-steel wire cages bent into 2-cm-long segments in a "zigzag" configuration. This urethane-covered stent is 18 mm in diameter, with 25-mm flanged ends, and must be compressed into a 28F catheter delivery system prior to placement. The Z-stent has good expansible force, and a new design incorporates an antireflux valve for bridging the gastroesophageal (GE) junction.

Video Endoscopic Sequence 14 of 27 .

 A follow up endoscopy four weeks after the stent was
 placed.

 The Z-stent consists of a series of stainless-steel wire
 cages bent into 2-cm-long segments in a "zigzag"
 configuration. This urethane-covered stent is 18 mm in
 diameter, with 25-mm flanged ends, and must be
 compressed into a 28F catheter delivery system prior to
 placement.The Z-stent has good expansile force, and a
 new design incorporates an antireflux valve for bridging the
 gastroesophageal (GE) junction.
                                          Medline.
In this image and the video clip, the stent is appreciated, that is emerging from the cardias. retroflexed image, the adenocarcinoma is constricting the cardias.

Video Endoscopic Sequence 15 of 27 .

 In this image and the video clip, the stent is appreciated,
 emerging from the cardias. Retroflexed image, the
 adenocarcinoma is constricting the cardias.

Esophageal stent placed four weeks previously, retroflexed view of the stent emerging through the tumor into the stomach.

Video Endoscopic Sequence 16 of 27 .

More images and videos.

 Esophageal stent placed four weeks previously,
 retroflexed view of the stent emerging through the tumor
 into the stomach.

 

 
Fluroscopy image.

Video Endoscopic Sequence 17 of 27 .

Fluroscopy image.

 
Six months after the placement of the stent. The patient had several episodes of hematemesis and melena requiring multiple blood transfusion. The image as well as the video clip show the superior third of the stent.

Video Endoscopic Sequence 18 of 27 .

 Six months after the placement of the stent.

 The patient had several episodies of hematemesis and
 melena requiring multiple blood transfusion.

 The image as well as the video clip show the superior third
 of the stent.
While repeated stenting is usually successful, debridement and laser vaporisation are viable alternatives for proximal tumour overgrowth or ingrowths in the upper or middle third of the esophagus. Distal tumour growth or ingrowths at the esophagus-gastric junction are best treated with a second stent Repeated treatment is justified, as survival following first re-intervention is comparable to that after initial stenting, particularly in those patients who are able to undergo chemotherapy or radiotherapy.

Video Endoscopic Sequence 19 of 27 .

 While repeated stenting is usually successful, debridement and
 laser vaporisation are viable alternatives for proximal tumour
 overgrowth or ingrowth in the upper or middle third of the
 esophagus. Distal tumour growth or ingrowth at the
 esophago-gastric junction are best treated with a second stent
 Repeated treatment is justified, as survival following first
 re-intervention is comparable to that after initial stenting,
 particularly in those patients who are able to undergo
 chemotherapy or radiotherapy.
Tumour progression. The gastric Adenocarcinoma has overgrowth into the stent. The image shows the site of the bleeding.

Video Endoscopic Sequence 20 of 27 .

 Tumour Progression.

 The gastric adenocarcinoma has overgrowth into the stent.
 The image shows the site of the bleeding.

 
The resource implications of re-intervention should be considered in the overall assessment of palliative care.

Video Endoscopic Sequence 21 of 27 .

 The resource implications of re-intervention should be
 considered in the overall assessment of palliative care.

Argon Plasma Coagulator has been used to stop the bleeding. One of the indications of using APC is Treatment of obstruction resulting from tumor ingrowth into the GI tract, particularly when the ingrowth has occurred with a previously placed stent in the digestive tract.

Video Endoscopic Sequence 22 of 27 .

 Argon Plasma Coagulator has been used to stop the
 bleeding.

 One of the indications of using APC is:
 Treatment of obstruction resulting from tumor ingrowth
 into the GI tract, particularly when the ingrowth has
 occurred with a previously placed stent in the digestive
 tract. to recanalize occluded or overgrown metal stents or
 cut displaced metal stents.
This image shows the exactly site of the hemorrhage which emerge from the tumour.

Video Endoscopic Sequence 23 of 27 .

 This image shows the exactly site of the hemorrhage which
 emerge from the tumor.
More application of coagulation with Argon Plasma.

Video Endoscopic Sequence 24 of 27.

 More application of coagulation with Argon Plasma
 Coagulator used to Debridement and stop the bleeding.
 Debridement was suitable also for ingrowth.

 

 
View through the stent. The antireflux valves apper to be destroyed for the gastric acid and the tumor.

Video Endoscopic Sequence 25 of 27.

View through the stent.

The antireflux valves apper to be destroyed for the gastric
acid and the tumor.

Gastric Cardias in retroflexed view. The adenocarcinoma is observed with no ulceration at this site and the stent emerge from the esophagus.

Video Endoscopic Sequence 26 of 27 .

Gastric Cardias in retroflexed view.

 The adenocarcinoma is observed with no ulceration at this
 site and the stent emerge from the esophagus.
Gastric Cardias in retroflexed view.

Video Endoscopic Sequence 27 of 27 .

Gastric Cardias in retroflexed view.
Palliative treatment for gastric carcinoma that has caused dysphagia and partial obstruction at the cardias. The image and the video clip display a retroflexed image that have a infiltrating gastric carcinoma. The patient has liver metastasis.

Video Endoscopic Sequence 1 of 8.

 Palliative treatment for gastric carcinoma that has caused
 dysphagia and partial obstruction at the cardias.
 The image and the video clip display a retroflexed image
 that have a infiltrating gastric carcinoma. The patient has
 liver metastasis. 

 
The image and the video display the argon plasma coagulation catheter with violet light. Therapy with argon plasma coagulator (APC). Argon Plasma Coagulation, or APC for short, is a new method of electrocoagulation. As a result, it allows for the non-contact application of electrical energy to achieve tissue destruction or hemostasis (the ability to stop bleeding). APC uses high frequency electrical current delivered via ionized argon gas. This gas, being ionized, allows for the conduction of electricity, thus leading to the term argon plasma.

Video Endoscopic Sequence 2 of 8.

 The image and the video display the argon plasma
 coagulation catheter with violet light.
 Therapy with argon plasma coagulator (APC).
 Argon Plasma Coagulation, or APC for short, is a new
 method of electrocoagulation. As a result, it allows for the
 non-contact application of electrical energy to achieve
 tissue destruction or hemostasis (the ability to stop
 bleeding). APC uses high frequency electrical current
 delivered via ionized argon gas. This gas, being
 ionized, allows for the conduction of electricity, thus
 leading to the term "argon plasma".
The video clip displays the power of the argon plasma coagulation onto the carcinoma. We used a higher power setting of 120 W per APC session.

Video Endoscopic Sequence 3 of 8.

 The video clip displays the power of the argon plasma
 coagulation onto the carcinoma.
 We used a higher power setting of 120 W per APC session.
 

 

 

                                          Medline.
Another image and video clip in which they are observed the power exerted by argon towards the tumor.

Video Endoscopic Sequence 4 of 8.

 Another image and video clip in which they are observed
 the power exerted by argon towards the tumor.
 

 
We recomended that you download the complete sequence to apreciated this therapeutical treatment as a palliative.

Video Endoscopic Sequence 5 of 8.

 We recomended that you download the complete sequence
 to apreciated this therapeutical treatment as a palliative.
More image and video clip of this treatment. The APC probe produces a plasma arc that destroys tissue to a depth of approximately 2 to 3 mm.

Video Endoscopic Sequence 6 of 8.

 More image and video clip of this treatment.
 The APC probe produces a plasma arc that destroys tissue
 to a depth of approximately 2 to 3 mm.

 
The argon beam is destroying some carcinomatous tissue. Argon plasma coagulation (APC) is an ablative endoscopic technique.

Video Endoscopic Sequence 7 of 8.

 The argon beam is destroying some carcinomatous tissue.
 Argon plasma coagulation (APC) is an ablative endoscopic
 technique.
Cardias is infiltrated with carcinomatous tissue. The image and the video clip displayed some nodules that invades the esophagus.

Video Endoscopic Sequence 8 of 8.

 Cardias is infiltrated with carcinomatous tissue.
 The image and the video clip displayed some nodules that
 invades the esophagus. 

A 28 year-old female with acute upper gastrointestinal bleeding due to a gastric carcinoma in the posterior wall of the gastric corpus near the fundus. A clot is covering the ulcerated carcinoma. At that time the biopsies did not revea malignancy.

Video Endoscopic Sequence 1 of 10.

 This sequence shows the evolution of a gastric carcinoma
 without a treatment.

 A 28 year-old female with acute upper gastrointestinal
 bleeding due to a gastric carcinoma in the posterior wall of
 the gastric corpus near the fundus. A clot is covering the
 ulcerated carcinoma. At that time the biopsies did not revea
 malignancy.
  
The ulcerated carcinoma is seen without the blood clot, in retroflexed view. At that time multiples fourth quadrant were negative to malignancy.

Video Endoscopic Sequence 2 of 10.

 The ulcerated carcinoma is seen without the blood clot, in
 retroflexed view. At that time multiples fourth quadrant
 were negative to malignancy.

40 days after, a second endoscopy was performed the ulcer was active. The referring physician had only given treatment for 15 days, but not signs of healing was observed due to the lack of healing signs, we suspected for malignancy, the biopsies remained negatives at that time. The Patient was then instructed to have a new evaluation in one month after the treatment and new multiples biopsies, but the patient did not return.

Video Endoscopic Sequence 3 of 10.

 40 days after, a second endoscopy was performed the
 ulcer was active. The referring physician had only given
 treatment for 15 days, but not signs of healing was
 observed due to the lack of healing signs, we suspected for
 malignancy, the biopsies remained negatives at that time.
 The Patient was then instructed to have a new evaluation
 in one month after the treatment and new multiples
 biopsies, but the patient did not return.

The patient did not return until 21 months later. An enormous ulcerated carcinoma was detected. No weight loss was reported.

Video Endoscopic Sequence 4 of 10.

 The patient did not return until 21 months later.
 An enormous ulcerated carcinoma was detected.
 No weight loss was reported.
      

Gastric Carcinoma that invades the fundus and the cardias. At surgery, the pancreas was found to be infiltrated as well as the celiac trunk. This are criteria of non-operability. Patient was 29 year-old.

Video Endoscopic Sequence 5 of 10.

 Gastric Carcinoma that invades the fundus and the
 cardias.
 At surgery, the pancreas was found to be infiltrated as
 well as the celiac trunk. This are criteria of non-operability.
 Patient was 29 year-old.
    
The cardias is infiltrated by the carcinoma.

Endoscopic Sequence 6 of 10.

 The cardias is infiltrated by the carcinoma.
We used therapeutical endoscopy using argon plasma coagulator as a palliative therapy, The argon plasma coagulator is suitable for palliative tumor therapy. The argon plasma coagulator is suitable for palliative tumor therapy.

Video Endoscopic Sequence 7 of 10.

 We used therapeutical endoscopy using argon plasma
 coagulator as a palliative therapy.
 The argon plasma coagulator is suitable for palliative
 tumor therapy.
Therapeutical endoscopy using argon as a palliative therapy.

Video Endoscopic Sequence 8 of 10.

 More images and video clips of therapeutical endoscopy
 using argon as a palliative therapy.
The video clip displays the argon beam against the tumor.

Video Endoscopic Sequence 9 of 10.

 The video clip displays the argon beam against the tumor.
Statust post using argon plasma coagulator for infiltrating gastric adenocarcinoma to the esophagus.

Video Endoscopic Sequence 10 of 10.

 Statust post using argon plasma coagulator for infiltrating
 gastric adenocarcinoma to the esophagus.
Barrett's Esophagus and Adenocarcinoma of the Gastroesophageal Junction. Palliation of Dysphagia of Esophageal Cancer by Endoscopic Lumen Restoration. This is the case of a 81 year old male with long standing GERD, obesity, his weight of 260 pounds, one month previously presented with dysphagia. Adenocarcinoma that arising from Barrett esophagus is seen. The recanalization of the lumen was achieved with the combination of ablative therapy using Argon Plasma Coagulation (APC) and dilation with hydrostatic balloon.

Video Endoscopic Sequence 1 of 26.

Barrett's Esophagus and adenocarcinoma of the Gastroesophageal Junction.

 Palliation of Dysphagia of Esophageal Cancer by
 Endoscopic Lumen Restoration.

 This is the case of a 81 year old male with long standing
 GERD, obesity, his weight of 260 pounds, one month
 previously presented with dysphagia.

 Adenocarcinoma that arising from Barrett esophagus is
 seen.

 The recanalization of the lumen was achieved with the
 combination of ablative therapy using Argon Plasma
 Coagulation (APC) and dilation with hydrostatic balloon.