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INTRODUCTIONGastric antral vascular ectasia (GAVE) is a condition characterized by vascular lesions usually located in the antrum, typically leading to occult or overt bleeding. It accounts for up to 4% of all non-variceal upper gastrointestinal bleeding and can be present in 6-14% of patients with cirrhosis. 1,2 Patients commonly present with chronic iron deficiency anemia, and up to 62% of patients can become transfusion-dependent. 3 Diagnosis is usually established using esophagogastroduodenoscopy (EGD); however, ambiguous cases require histologic assessment. [4][5][6] Endoscopically, it may present with three different patterns: stripes radiating to the pylorus (classically called "watermelon stomach, " more common in non-cirrhotic patients), diffuse punctate lesions (more common in cirrhotic patients), and a nodular type. 7,8 Pharmacological therapies have been shown to have limited benefit. 9-12 Antrectomy has a higher morbidity and mortality. 5

Although laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgery worldwide, postsleeve leaks may occur in up to 5.3 % of patients [1]. More recently, novel endoscopic draining therapies including endoscopic vacuum therapy, septotomy, and the use of endoluminal double-pigtail stents (DPS) have been deployed [2][3][4]. In this video, we describe successful E-VideosVideo 1 Endoscopic techniques for post-bariatric surgery leaks and fistulas. ▶ Fig. 1 Fluoroscopic imaging demonstrating a large perigastric fluid collection from an acute sleeve leak within the residual fundus after laparoscopic sleeve gastrectomy. ▶ Fig. 3 Fluoroscopic imaging confirming appropriate positioning of the two double-pigtail plastic stents to achieve successful endoscopic internal drainage. ▶ Fig. 2 Endoscopic imaging showing the leak orifice. de Moura Diogo Turiani Hourneaux et al. Endoscopic management of … Endoscopy |

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See YouTube Video on our YouTube Channel: https:// youtu.be/L8VDbHrmHWk PRELIMINARY RESULTS: A total of 13 female patients underwent colonoscopic ultrasound. All patients (100%, 13/13) were successfully scanned. Fine-needle aspiration was deemed necessary and successfully performed in 100% (5/5) of the patients. Tissue samples collected by fine-needle aspiration resulted in a diagnostic yield of 60%, and no adverse events resulted from this intervention.CONCLUSIONS: This study demonstrates the feasibility of performing colonoscopic ultrasound with a curvilinear array transducer. Fine-needle aspiration for subepithelial, colonic, and extracolonic lesions is feasible and safe in this setting with no adverse events reported in our study. FUTURE DIRECTIONS: Future research should be directed toward validating colonoscopic ultrasound with a curvilinear array transducer technique in prospective randomized trials. Studies evaluating the feasibility and safety of endoscopic ultrasound-guided interventions in the colon, such as abscess drainage and enteral anastomosis, should be considered.

Background and study aim: Significant weight regain affects up to a third of patients after Roux-en-Y Gastric Bypass (RYGB) and demands treatment. The transoral outlet reduction (TORe) with Argon Plasma Coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short. However, no study has investigated the course of the gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedural year. Patients and methods: Patients eligible for a 36-month follow-up visit after TORe underwent upper GI endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJA size. Comparisons between APC and APC-FTS TORe were a secondary aim. Results: Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to preprocedural levels. Only the energy/fatigue domain improvement was kept between the one and 3-year visits. Conclusions: Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered an iterant rather than a one-off procedure.

Organized pancreatic and peripancreatic collections are complications of pancreatitis and should be treated when symptomatic or complicated. When feasible, the endoscopic ultrasound approach presents high efficacy and low morbidity and mortality, making it the first likely option. Among the available accessories for endoscopic drainage, the lumen-apposing metal stent can be a better option, with a low migration rate; furthermore, it allows endoscopic necrosectomy. Here, we present the case of complex walled-off necrosis treated with two lumen-apposing metal stents in the same procedure.A 41-year-old male patient with walled-off necrosis presented with delayed gastric emptying and obstruction of the main biliary duct. Magnetic resonance imaging and endoscopic ultrasound revealed two non-communicating collections. We opted for endoscopic ultrasound-guided drainage with the deployment of two simultaneous lumen-apposing metal stents: one transduodenal and the other transgastric, with clinical improvement. After three weeks, endoscopic retrograde cholangiopancreatography showed a biliary fistula communicating with the periduodenal collection, which was treated with a biliary plastic stent. An endoscopic necrosectomy was performed, and the metal stents were removed. Control magnetic resonance imaging demonstrated improvement. The patient was asymptomatic at the six-month follow-up.The treatment of symptomatic complex walled-off necrosis remains a challenge and may require multiple endoscopic approaches; moreover, surgical treatment may be necessary in case of failure. In the present report, we demonstrate that the deployment of two lumen-apposing metal stents in the same procedure is feasible when necessary as it was associated with technical success and short-term clinical success.