Case of the Week 633
This week ' s case was generously donated by Dr. Neil Anderson. The following structure was retrieved from the common bile duct during endoscopic retrograde cholangiopancreatography (ERCP). The patient is a refugee from Tanzania who presented with intermittent abdominal pain, distended gallbladder and hepatosplenomegaly. This was one of many " worm like " structures noted on ERCP. Unfortunately this object appeared to tear during removal. The portion submitted measures several centimeters in length. No identifying external structures were identified.Dr. Anderson ' s team tried to express eggs from this str...
Source: Creepy Dreadful Wonderful Parasites - April 6, 2021 Category: Parasitology Source Type: blogs
A gastroenterologist ’s COVID musings from behind the mask
I was recently asked to see an 89-year-old woman who was gravely ill in the intensive care unit. She was admitted with cholangitis due to bile duct stones causing complete obstruction leading to septic shock. It is a life-threatening situation, especially in elderly patients. She needed an emergency endoscopic procedure: ERCP. By the way, one […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 14, 2020 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/sripathi%e2%80%8b-kethu" rel="tag" > Sripathi Kethu, MD < /a > < /span > Tags: Conditions COVID-19 coronavirus Gastroenterology Infectious Disease Source Type: blogs
FDA Clears Olympus TJF-Q190V Duodenoscope With Disposable Endcap
Olympus received FDA clearance for its TJF-Q190V duodenoscope that features a single-use endcap and novel flushing adapter that reduce the chance for pathogens to settle between cases. Olympus touts that the new device has a large field of view, a reliable guidewire locking system, and precise handling.
Duodenoscopes are used to perform endoscopic retrograde cholangiopancreatography (ERCP) procedures as an option over open surgery. A few years ago duodenoscopes were identified as carriers of infections, due to flawed design and insufficient processing, and even led to a number of patient deaths. The industry had to rei...
Source: Medgadget - February 4, 2020 Category: Medical Devices Authors: Medgadget Editors Tags: GI Surgery Source Type: blogs
FDA Clears First Completely Disposable Duodenoscope
A few years ago it was discovered that duodenoscopes, which are used in Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedures, were bacterial vectors, spreading disease between patients and even causing multiple deaths. This was due to insufficient processing, so some manufacturers put out devices that are easier to clean, while others developed snap on covers to protect the working ends from infection, and yet others made those ends disposable.
Boston Scientific just won FDA clearance for its EXALT Model D duodenoscope that’s entirely disposable, alleviating all need for cleaning, processing, and ...
Source: Medgadget - December 16, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: GI Surgery Source Type: blogs
PENTAX Medical ’s DEC HD Partially Disposable Duodenoscope FDA Cleared
PENTAX Medical is releasing its DEC HD duodenoscope, a high-definition device that uses disposable distal caps and elevator levers, in the United States. The capability to simply throw away the components that tend to harbor bacteria, associated with the transmission of disease and even death, helps to guarantee that there’s little chance of passing pathogens between patients.
The duodenoscope, already introduced in many other countries two years ago, allows for high fidelity imaging during endoscopic retrograde cholangiopancreatography (ERCP) procedures while benefiting from quick reprocessing and a much reduced ...
Source: Medgadget - November 21, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: GI Surgery Source Type: blogs
ScopeSeal, A Snap-on Shield to Keep Duodenoscopes Clean from Infections
ScopeSeal, an Arlington, Virginia firm, has won FDA clearance for the first duodenoscope attachment that helps to protect the imaging end from infections.
Duodenoscopes are used in Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedures. A few years ago it was discovered that they are carriers of infections, because of design flaws and insufficient processing, causing multiple deaths as well as a shock to the scope industry. The ScopeSeal helps to make sure that pathogens don’t get a chance to make contact with the elevator end of a duodenoscope, where bacteria tend to have an easier time settling.
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Source: Medgadget - October 29, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: GI Surgery Source Type: blogs
The Folly of Self Referral
By HANS DUVEFELT, MD
A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock.
This “system” often doesn’t work, because of the way medical specialties are divided up.
If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the cause is Crohn’s disease, any gastroenterologist will do, but with Sphincter of Oddi problems, you’ll need a gastroenterologist who does ERCPs, and not all of them do. Now, of ...
Source: The Health Care Blog - May 17, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Hans Duvefelt primary care Source Type: blogs
It ’s time to talk about private equity in gastroenterology
Well, they are calling it the golden age of rectums! The trends are simple and straightforward. First, Baby Boomers and beyond are aging and staying alive longer. The gut, a hidden culprit behind many ailments, requires continuous maintenance. Colonoscopies, EGDs and ERCPs. These require services of gastroenterologists (GIs) who are always in short supply (14,000 […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/praveen-suthrum" rel="tag" > Praveen Suthrum < /a > Tags: Physician Gastroenterology Source Type: blogs
Uncontrollable itching – the denouement
The emergency department ordered a CT scan that showed a dilated common bile duct, no pancreatic masses, a mass in the duct – stone versus other.
Twelve hours after admission, he developed a temperature of 101 and a repeat CBC showed an elevated WBC with left shift.
Therefore, GI did an ERCP the next day – revealing a large gallstone – not easily removable. The placed a stent and drained pus.
So this man had painless jaundice from a common duct stone.
As an intern in 1976 I had a patient with ascending cholangitis. His internist told me that he had pancreatic cancer, but had declined surgery. In 197...
Source: DB's Medical Rants - March 21, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse cutaneous systemic sclerosis.
On physical examination, temperature is normal, blood pressure is 146/92 mm Hg, pulse rate is 94/min, and respiration rate is 16/min. BMI is 19. Cardiopulmonary examination is normal. ...
Source: Kevin, M.D. - Medical Weblog - October 21, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Rheumatology Source Type: blogs
Pentax Unveils Easier to Clean Duodenoscopes Thanks to Disposable Business End
Endoscopes in general can be tricky to clean, a serious problem in the industry, but duodenoscopes have something called an elevator that makes them particularly challenging to disinfect. The elevator is a moving component at the business end of the duodenoscope. PENTAX Medical, a part of HOYA Group, has announced receiving CE Mark clearance for its new DEC Duodenoscope, a device that features a disposable elevator cap.
The PENTAX DEC Duodenoscope has a disposable tip, so the most challenging area of cleaning doesn’t have to be cleaned anymore. The rest of the scope is still reusable, but it’s now as challengi...
Source: Medgadget - September 19, 2017 Category: Medical Devices Authors: Editors Tags: GI Surgery Source Type: blogs
LessRay Radiation Reduction System for ORs Using Fluoroscopes
NuVasive, a company based in San Diego, California, is now making available its LessRay radiation dose-reduction system. It consists of a computer cart that connects to an operating room’s fluoroscopy system. The fluoroscope can be set to a lower level of X-ray exposure, and the LessRay, using its proprietary software algorithms, then corrects the image to achieve a quality that would have been produced using a standard exposure. The system is expected to be used particularly during minimally invasive spinal surgical procedures, but should also be applicable in other applications when repeat exposures are required (...
Source: Medgadget - September 18, 2017 Category: Medical Devices Authors: Editors Tags: Cardiology Neurosurgery Orthopedic Surgery Radiology Thoracic Surgery Urology Vascular Surgery Source Type: blogs
Olympus Releases New Endotherapy Tools in U.S.
At the Digestive Disease Week event in Chicago this week, Olympus is releasing a few endoscopic devices including the SB Knife monopolar ESD (Endoscopic Submucosal Dissection) knife and two new sphincterotomes, the CleverCut3V Distal Wireguided Oblique Tip and the CleverCut3V Distal Wireguided Short Bend Tip.
The SB Knife is designed to remove early gastric cancers that have yet to penetrate into the muscle layer. The “SB” in the name of the device stands for “stag beetle,” as the tool’s pincers resemble those of the said beetle. It allows for removal of lesions as one mass without having...
Source: Medgadget - May 8, 2017 Category: Medical Equipment Authors: Editors Tags: GI Source Type: blogs
MKSAP: 28-year-old man with elevated liver chemistry test result
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated in follow-up for elevated liver chemistry test results, which were performed to assess a 3-month history of fatigue. He has no history of liver disease and has not had abdominal pain or fever. His medical history is significant for a 3-year history of diarrhea. Following a physical exam, lab results, and abdominal CT, what is the most appropriate next step in management?
On physical examination, vital signs are normal; BMI is 24. Spider angiomata and jaundice are absent. Abdominal ...
Source: Kevin, M.D. - Medical Weblog - March 18, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions GI Source Type: blogs
A Better Pathway to Acute Care
By KAREN SIBERT, MD
When patients need acute interventional care, coordinating the transitions away from and back to primary care is a challenge. The common pathway for these patients, no matter what their diagnosis, is an encounter with anesthesiology. But it often happens too late in the process. If we’re involved earlier, physician anesthesiologists can help reduce procedure risk, control costs, and improve the long-term health of this high-risk, high-spend population.
The numbers haven’t changed significantly in several years—only five percent of the U.S. population consumes a full ...
Source: The Health Care Blog - February 21, 2016 Category: Consumer Health News Authors: Simon Nath Tags: Featured THCB Karen Sibert Source Type: blogs
