1. A 72 y/o male with h/o CAD, NIDDM & mild GERD for 6-7 yrs on occasional PPI who started to have intermittent solid food dysphagia for few weeks. His EGD showed a 1.5 cm nodule at the EGJ & biopsy revealed adenocarcinoma. PMH/PSH: NIDDM x 25 yrs; CAD & CABG in ’02/stents in ’03. PMH/PSH: NIDDM x 25 yrs; CAD & CABG in ’02/stents in ’03. MED: Plavix, Avandia, Metformin, & Nexium. MED: Plavix, Avandia, Metformin, & Nexium. ALL: Niacin ALL: Niacin SH: Tobacco 1p/d x 20 yrs & quit 30 yrs ago; No ETOH or IVDA. SH: Tobacco 1p/d x 20 yrs & quit 30 yrs ago; No ETOH or IVDA. FH: Mother had larynx ca & both sisters had lung ca. FH: Mother had larynx ca & both sisters had lung ca. ROS: Noncontributory. ROS: Noncontributory. PE: Essentially unremarkable. PE: Essentially unremarkable. LAB: CBC-diff, SMA-6, PT & INR were WNL. LAB: CBC-diff, SMA-6, PT & INR were WNL. Abd/pelvic CT Abd/pelvic CT Upper EUS Upper EUS FH

2. ENDOSCOPIC MUCOSAL RESECTION

3. ENDOSCOPIC MUCOSAL RESECTION ENDOSCOPIC MUCOSAL RESECTION

6. A 77 y/o female with a COPD who has been seen by TMH/BCM liver team with an obstructive jaundice in Jan ’00 and referred for a surgical consult. Denied fever, wt loss, pruritis, GIB. A 77 y/o female with a COPD who has been seen by TMH/BCM liver team with an obstructive jaundice in Jan ’00 and referred for a surgical consult. Denied fever, wt loss, pruritis, GIB. MED: Cipro, Actigall MED: Cipro, Actigall PMH: COPD for 10-12 yrs. PMH: COPD for 10-12 yrs. SH: Tobacco 1 p/d for 50yrs, no ETOH or IVDA SH: Tobacco 1 p/d for 50yrs, no ETOH or IVDA FH & ROS: Noncontributory FH & ROS: Noncontributory PE: VSS, icteric & chest increased AP diamater, prolonged expirium, hepatomegaly. PE: VSS, icteric & chest increased AP diamater, prolonged expirium, hepatomegaly. LAB: WBC 11, H/H 14.6/41, Pl 171& lyts, FBS, LAB: WBC 11, H/H 14.6/41, Pl 171& lyts, FBS, PT, INR were all WNL. Alk.phos. 378, bil. PT, INR were all WNL. Alk.phos. 378, bil. 6.8 & ALT/AST 147/128. 6.8 & ALT/AST 147/128. Abd US& abd/pelvic CT Abd US& abd/pelvic CT ERCP ERCP

7. ENDOSCOPIC PAPILLECTOMY in a 77 y/o female with adenoma 11/9/20005/12/2005

8. ENDOSCOPIC PAPILLECTOMY in a 68 y/o female with adenoma ENDOSCOPIC PAPILLECTOMY in a 68 y/o female with adenoma

9. EMR in a 64 y/o male with cecal villousadenoma

10. EMR in a 83 y/o female with rectal villousadenoma EMR in a 83 y/o female with rectal villousadenoma

11. EMR in a 64 y/o male with 7 cm rectal villousadenoma EMR in a 64 y/o male with 7 cm rectal villousadenoma 9/15/2000 11/1/2001 4/21/2001 6/17/2005

12. ENDOSCOPIC MUCOSAL RESECTION (EMR) EMR first proliferated in Japan. EMR first proliferated in Japan. The EMR combines the therapeutic power of endoscopic procedure with the diagnostic power of pathology exam of resected neoplastic lesion in selected cases. The EMR combines the therapeutic power of endoscopic procedure with the diagnostic power of pathology exam of resected neoplastic lesion in selected cases. Saline assisted or cap-assisted EMR have been safe and effective for GI mucosal cancers. Saline assisted or cap-assisted EMR have been safe and effective for GI mucosal cancers. EMR using electrocautery knives has shown safe & EMR using electrocautery knives has shown safe & effective for submucosal lesions in expert hands. effective for submucosal lesions in expert hands. Gastrointest Endosc 59: 171 & 273, 2004. Gastrointest Endosc 59: 171 & 273, 2004. Endoscopy 38: 521, 2005 Endoscopy 38: 521, 2005

16. ENDOSCOPIC PAPILLECTOMY (EP) Ampullary adenomas can be removed by combination of EP & APC in selected cases after prophylactic pancreatic and sometimes biliary stenting. Ampullary adenomas can be removed by combination of EP & APC in selected cases after prophylactic pancreatic and sometimes biliary stenting. These lesions can progress through an adenoma- carcinoma sequences. These lesions can progress through an adenoma- carcinoma sequences. Complications of EP occurred in about 20% such as bleeding, perforation & pancreatitis. Complications of EP occurred in about 20% such as bleeding, perforation & pancreatitis. Depending upon the size & path of the lesion, appropriate post-EP surveillance is needed. Depending upon the size & path of the lesion, appropriate post-EP surveillance is needed. Gastrointest Endosc 62: 367 & 551, 2005. Gastrointest Endosc 62: 367 & 551, 2005. Current Opinion in Gastroenterol 20: 40, 2004. Current Opinion in Gastroenterol 20: 40, 2004. Gut 53: 381,2004. Gut 53: 381,2004.