POEM: implications for the future

Endoscopic mucosal resection (EMR) is a method for treating early gastrointestinal mucosal lesions. The procedure of EMR involves submucosal injection of normal saline or saline with a mix of methylene blue to separate the lesion from the underlying muscle layers. The raised lesions can be completely removed with a snare. EMR is a simple and safe procedure with a small learning curve.
The risk of serious complications such as perforation and bleeding is rare.
The invasion depth of the tumor can be assessed after resection using pathological examination. The recurrence rate is very low (0-3.6%) after resection. EMR is not an appropriate choice for gastrointestinal tumors (size >20mm) as the complete recurrence rate is very low and recurrence after resection is very high.

In this lecture, Dr. Toyonaga presents indications, contraindications and his experience in performing endoscopic submucosal dissection (ESD) with the water jet short needle knives (Flush knife), proving that a complete resection is possible with a low rate of perforation.

Confocal laser endomicroscopy (CLE) is a new diagnostic technique that allows microscopic examination of the digestive mucosa during ongoing endoscopy. Different types of tissue and diseases can be diagnosed immediately, and analysis of the in vivo microarchitecture is helpful to better target standard biopsies and reduce the number of biopsies required. In this lecture, this interesting technique is presented.

In this key lecture, Dr. Inoue outlines his large experience in endoluminal minimally invasive gastrointestinal procedures.

In this key lecture, Dr. Brian Dunkin details the Barrett’s esophagus pathology as well as the different possible ablative procedures.

In this key lecture, Dr. Costamagna outlines the management of postoperative biliary injuries.

Barrett's esophagus with high grade intra-epithelial neoplasia is associated with disease progression at rates greater than 10% per year. Endoscopic resection is a lower risk alternative to surgery for the management of high grade intra-epithelial neoplasia and intramucosal cancer. In this lecture, Dr. Stefan Seewald presents the indications and the technique for endoscopic mucosal resection of Barrett’s esophagus. The results of a prospective study comparing total endoscopic resection and endoscopic mucosal resection of visible lesions with radiofrequency ablation are also presented.

In this key lecture, Dr. Coron outlines the assistance of endoscopic approaches to surgical complications, presenting cases of fistula and stenosis treatment.

In this video, we present the performance of an endoscopic ultrasound-guided drainage of pleural effusion and collection in the posterior mediastinum. The technical aspects of the procedure and a discussion are provided.