Endoscopic sleeve gastroplasty: live uncut procedure

Fifteen per cent of rectal cancers are unresectable because of local extension or metastasis.
Endoscopic palliative treatments have been described to avoid surgical palliative procedures (ileostomy, colostomy), which inevitably affect the patient's quality of life.
Endoscopic electrocoagulation, laser therapy and cryotherapy have been used for this purpose, but they need multiple therapeutic sessions: these have a high cost and cause patient discomfort.
Permanent stenting with Self Expanding Metal Stents (SEMS) has been increasingly used for the palliative treatment of obstructing gastrointestinal tumors.
This is the case of a 74-year-old man with an adenocarcinoma of the rectum, T4 N+ M+, that was admitted to our surgical department with sub-occlusion and rectal bleeding.
Under endoscopic-fluoroscopic control, a SEMS was delivered with no complications and the patient was discharged the day after. He was scheduled for a palliative chemotherapy.
Endoscopic stent introduction is a safe palliative procedure performed to improve the quality of life of patients with inoperable tumors of the rectum.

POEM (PerOral Endoscopic Myotomy) is a therapeutic endoscopic procedure performed for esophageal achalasia by usually using high-definition upper endoscopes. In this video, Dr. Swanström and Dr. Perretta demonstrate the main principles of POEM in a patient with achalasia. An incision is made in the esophageal mucosa and tunneling of the submucosal layer to reach the muscular layer. The myotomy of the selected region is performed and the incision is closed by means of clips.

In this key lecture, Dr. Perretta outlines endoscopic sleeve gastroplasty (ESG).

This video shows the case of a 56-year-old man with a T2N2M1 sigmoid cancer managed under radiochemotherapy referred for bowel obstruction without gas and without faeces for four days, with a dilated abdomen. An abdominal CT-scan confirmed the colonic obstruction caused by an obstructing lesion at the rectosigmoid junction, 18cm away from the anal verge. An endoscopic colonic stenting is demonstrated.

Patients with liver cirrhosis present with portal hypertension (PHT), which causes various pathological changes in the entire gastrointestinal tract (from esophagus to anus). In this video, the Mallory Weiss tear (MWT) occurred accidentally during ESD of a gastric antral adenoma in a cirrhotic patient. It was successfully managed by means of endoscopic clipping. The patient had two episodes of retching during endoscopy, which might have contributed to gastric over-distension. With esophagogastroduodenoscopy (EGD) being so commonly performed in cirrhotic patients and ESD being more and more commonly used for treatment of gastric mucosal lesions, this case report should serve as a precautionary reminder in such case scenarios.

The most frequent complications after upper GI surgery are leaks and stenosis. These complications are associated with significant morbidity and mortality rates.
Conservative treatments such as Self-Expanding Metal Stents (SEMS) and balloon dilatation have been described for the treatment of these complications, but stay controversial yet.
We report a case of a 66-year-old woman who underwent a total gastrectomy for a neuro-endocrine tumor that developed an anastomotic dehiscence six days after surgery, successfully treated with a covered SEMS. The stent was well-tolerated and left in place for two weeks. Its ablation confirmed through endoscopic and enhanced X-ray upper series the development of a granulation tissue, along with epithelial proliferation, enough to produce a perfectly closed and healing anastomotic defect. No further surgery was required; oral feeding was started and has been well-tolerated and the patient was soon discharged.
In this case where the use of surgery seemed inevitable and not risk-free, the placement of a removable SEMS was demonstrated to be a safe and efficient technique.

Bariatric surgery has emerged as a highly effective treatment for obesity and is increasingly recognized to have benefits for glycemic management in patients with pre-existing type 2 diabetes mellitus (T2DM). Understanding the efficacy and physiological effects of bariatric surgery on metabolism will push forward a novel approach to interventional procedures for diabetes treatment. In this key lecture, Dr. Galvao Neto presents the first result of a novel endoscopic approach to type 2 diabetes, namely duodenal mucosal resurfacing.

Biliopancreatic stones are the ‘primum movens’ of acute pancreatitis. Pure pancreatic stones are rare. However, when present, they are the main cause of acute obstruction of the main pancreatic duct. Conversely, when present in chronic pancreatitis, they are mostly responsible for pancreatic glandular insufficiency. Medical treatment, radiologic evaluation (by MRI or CT-scan), and therapeutic endoscopy constitute the standard of care (SOC).
Here, we report the case of a 25-year-old man, admitted for upper middle abdominal pain and hyperamylasemia, without anomalies in liver function tests, and who underwent biliopancreatic EUS. A pancreatic stone was diagnosed and immediately treated by endoscopic pancreatic sphincterotomy and extraction.

Diverticular disease, angiodysplasia, polyps, hemorrhoids, and anal fissures are the most common causes of lower gastrointestinal bleeding. This video shows the hemostasis of a bleeding originating from a colic diverticulum.