In this presentation, we will demonstrate a EUS-Guided Anterograde Ureteral Internal Drainage in a patient with failure at retrograde approach by cystoscopy. By a single-step procedure, the EUS linear equipment was positioned at gastric greater curvature and it was possible HKI-272 order to observe the dilated proximal ureter. Doppler analysis was obtained to confirm the fact that it had

not any vessels nearby the working area. After that, it was performed a proximal ureteral puncture using a 19-Gauge needle. Contrast media was injected in proximal ureter and an urethrography was obtained. A 0.035-inch guidewire was passed in the left ureter. By progression of the guidewire, its distal part passed through the obstructed area and was positioned inside the bladder. Over the guidewire and under radioscopic view, an 8.5 Fr double-pigtail hydrophilic-coated stent was placed. The stent was positioned with the proximal part inside the ureter and the distal part inside the bladder. EUS-Guided Anterograde Ureteral Internal Drainage was a feasible technique

check details and the patient presented with improvement in renal function. EUS-Guided Anterograde Ureteral Internal Drainage is an alternative to the Percutaneous Nephrostomy, which can be considered for palliation of ureteral obstruction patients with advanced bladder cancer. Larger multicenter studies are needed to further assess this novel technique. “
“A 77 year old man with a history of hemochromatosis is found to have a new hepatocellular carcinoma approximately 3 years ago. His initial treatment included percutaneous RFA, partial hepatectomy, and retroperitoneal lymph node resection. Orotidine 5′-phosphate decarboxylase At 6 months post-op, a metastatic lymph node is discovered in the right retrocrural space. This was successfully treated by external radiation therapy (XRT). At 19 months post-op, a large metastatic lymph node is found in the aorto-caval region. This initially responded to XRT. However, 1

year later the lesion has increased in size and serum AFP is 93.4 ng/ml. Multidisciplinary evaluation pursued. Patient was not a candidate for further XRT. Surgery not an option. And percutaneous ablation was not felt to be feasible. EUS-guided ethanol ablation was thus offered as an a potential alternative. A linear echoendoscope was advanced to the duodenal bulb, where the metastatic lymph node was able to be visualized. A 22-gauge needle was advanced into the periphery of the lesion in a trans-duodenal approach. 98% ethanol was then slowly injected through the needle directly into the mass. A “blush” was seen at the site of ethanol injection. The needle was slowly withdrawn as the ethanol was injected, with care taken to avoid extravasation of the injectate. Ablation was performed at various sites throughout the tumor until an ablation effect was seen throughout the lesion. A total of 21 cc of ethanol was injected. Follow-up at 10 weeks demonstrated near-normalization of serum AFP (13.