Combined endoscopic biliary and duodenal SEMS insertion is safe and effective for palliation in malignant biliary and duodenal obstruction. Biliary stenting through the mesh of the duodenal SEMS is technically feasible and has a high success rate.

No abstract

Primary cardiac tumors are rare. Establishing histological diagnosis is technically challenging. We report on performing transesophageal endoscopic ultrasoundguided fine-needle biopsy (EUS-FNB) for a cardiac mass [1-4]. EUS offers advantages of real-time, image-guided targeting of lesions and use of Pro core biopsy needles, which improves tissue yield while avoiding fluoroscopy. A 26-year-old male presented to a cardiology clinic with recent-onset puffiness of face and shortness of breath that was suggestive of SVC syndrome for 4 weeks duration. Cardiac magnetic resonance imaging showed a large, bulky, infiltrative mass in the right atrium with pericardial extension (▶ Fig. 1). The mass Video 1 Video of linear EUS of the esophagus showing a mass in right atrium extending and causing nodular thickening of pericardium from which a core biopsy was obtained with FNB. Pericardial thickening, tracing IVC to heart, nodule in pericardium, large mass in right atrium, left heart chambers normal, mass extending into pericardium and along mediastinum, core biopsy from thickened pericardium.