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Focus On Flexible Gastrointestinal (GI) Endoscopy!

Epublication, Jan 2016;16(01). URL: http://websurg.com/doi/fc01en9
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LIVE INTERACTIVE SURGERY: POEM for type 2 achalasia and incidental esophageal leiomyoma
POEM (peroral endoscopic myotomy) is an emerging procedure, which has evolved from the era of NOTES. The most cardinal indication for POEM is achalasia of the cardia. Other indications include diffuse esophageal spasm, jackhammer esophagus, and surgically failed cases.
The steps of POEM include the following: mucosotomy, submucous tunnelling, myotomy, closure of mucosotomy.
The myotomy is started 2 to 3cm distal to the mucosotomy and is continued to the end of the tunnel at 2 to 3cm distally to the gastroesophageal junction (GEJ). A partial myotomy is most commonly performed by means of careful dissection of circular fibers, hence avoiding longitudinal fibers to prevent entry into the mediastinum. The mucosotomy is then closed to prevent any leakage with the use of endoscopic clips or of an endoscopic suturing device. About the EndoFLIP™ (Endolumenal Functional Lumen Imaging Probe) Imaging System: this is a functional endoluminal imaging probe, which helps in the assessment of gastroesophageal junction distensibility and compliance after the procedure.
Complications of POEM:
Inadvertent mucosotomy is the most common complication.
Complications due to insufflation (pneumomediastinum, pneumoperitoneum) can be controlled by using carbon dioxide for insufflation. Esophageal leak is the most dreaded complication with rates ranging from 0 to 5.6%.
H Inoue, S Perretta
Surgical intervention
2 years ago
956 views
32 likes
0 comments
31:42
LIVE INTERACTIVE SURGERY: POEM for type 2 achalasia and incidental esophageal leiomyoma
POEM (peroral endoscopic myotomy) is an emerging procedure, which has evolved from the era of NOTES. The most cardinal indication for POEM is achalasia of the cardia. Other indications include diffuse esophageal spasm, jackhammer esophagus, and surgically failed cases.
The steps of POEM include the following: mucosotomy, submucous tunnelling, myotomy, closure of mucosotomy.
The myotomy is started 2 to 3cm distal to the mucosotomy and is continued to the end of the tunnel at 2 to 3cm distally to the gastroesophageal junction (GEJ). A partial myotomy is most commonly performed by means of careful dissection of circular fibers, hence avoiding longitudinal fibers to prevent entry into the mediastinum. The mucosotomy is then closed to prevent any leakage with the use of endoscopic clips or of an endoscopic suturing device. About the EndoFLIP™ (Endolumenal Functional Lumen Imaging Probe) Imaging System: this is a functional endoluminal imaging probe, which helps in the assessment of gastroesophageal junction distensibility and compliance after the procedure.
Complications of POEM:
Inadvertent mucosotomy is the most common complication.
Complications due to insufflation (pneumomediastinum, pneumoperitoneum) can be controlled by using carbon dioxide for insufflation. Esophageal leak is the most dreaded complication with rates ranging from 0 to 5.6%.
LIVE INTERACTIVE SURGERY: Esophagogastroduodenoscopy (EGD), chromoendoscopy, and BARRX treatment of remaining Barrett's mucosa
Chromoendoscopy is a procedure where dyes are instilled in the gastrointestinal tract at the time of visualization with endoscopy. It enhances the characterization of the tissues. The most common applications are as follows:
- Identification of squamous cell carcinoma or dysplasia;
- Identification of Barrett’s esophagus;
- Detection of early gastric cancer;
- Characterization of colonic polyps;
- Screening.
BARRX™ is a radiofrequency ablation of the metaplastic esophageal mucosa. The concept is to resect the epithelium and the muscularis mucosa without damaging the submucosa. It reduces the risk of developing carcinoma.
E Coron, G Rahmi
Surgical intervention
2 years ago
411 views
20 likes
0 comments
09:12
LIVE INTERACTIVE SURGERY: Esophagogastroduodenoscopy (EGD), chromoendoscopy, and BARRX treatment of remaining Barrett's mucosa
Chromoendoscopy is a procedure where dyes are instilled in the gastrointestinal tract at the time of visualization with endoscopy. It enhances the characterization of the tissues. The most common applications are as follows:
- Identification of squamous cell carcinoma or dysplasia;
- Identification of Barrett’s esophagus;
- Detection of early gastric cancer;
- Characterization of colonic polyps;
- Screening.
BARRX™ is a radiofrequency ablation of the metaplastic esophageal mucosa. The concept is to resect the epithelium and the muscularis mucosa without damaging the submucosa. It reduces the risk of developing carcinoma.
LIVE INTERACTIVE SURGERY: Barrett's esophagus treatment using BARRX™ radiofrequency ablation (RFA) system
Barrett’s esophagus is a metaplastic change in the lining mucosa of the esophagus in response to chronic GERD. The hallmark of specialized Barrett’s epithelium is mucus-secreting goblet cells (intestinal metaplasia). There is an increased risk of adenocarcinoma with intestinal metaplasia. BARRX™ is a new treatment option for Barrett’s esophagus which uses Radio frequency energy and minimizes the risk of developing cancer.
Radio frequency energy is delivered via a catheter to the esophagus, lasts less than a second and creates superficial injury to the mucosa.
Principle: To deliver high power (approx. 300 Watts) in a short period of time. This will allow the depth of penetration to ablate the epithelium and the muscularis mucosa without injuring the submucosa. Overall results are excellent with elimination of dysplasia in 80% of patients and stricture rate to less than 6%.
Side effects: chest pain following the procedure, which can be treated with analgesics.
Bleeding, infection, and perforation requiring surgery are some of the rare complications.
Follow-up: endoscopy at 3 months and ablation repeated if required.
LL Swanström, V Wong
Surgical intervention
2 years ago
364 views
14 likes
0 comments
11:15
LIVE INTERACTIVE SURGERY: Barrett's esophagus treatment using BARRX™ radiofrequency ablation (RFA) system
Barrett’s esophagus is a metaplastic change in the lining mucosa of the esophagus in response to chronic GERD. The hallmark of specialized Barrett’s epithelium is mucus-secreting goblet cells (intestinal metaplasia). There is an increased risk of adenocarcinoma with intestinal metaplasia. BARRX™ is a new treatment option for Barrett’s esophagus which uses Radio frequency energy and minimizes the risk of developing cancer.
Radio frequency energy is delivered via a catheter to the esophagus, lasts less than a second and creates superficial injury to the mucosa.
Principle: To deliver high power (approx. 300 Watts) in a short period of time. This will allow the depth of penetration to ablate the epithelium and the muscularis mucosa without injuring the submucosa. Overall results are excellent with elimination of dysplasia in 80% of patients and stricture rate to less than 6%.
Side effects: chest pain following the procedure, which can be treated with analgesics.
Bleeding, infection, and perforation requiring surgery are some of the rare complications.
Follow-up: endoscopy at 3 months and ablation repeated if required.