Live interactive surgery: POEM for achalasia in a patient with a surgical history of subtotal gastrectomy

Endoscopic resection of tumoral lesions at an early stage is an accepted method. Among several methods of endoscopic resection, Endoscopic Submucosal Dissection (ESD) has been developed to remove the lesions in an ‘en bloc’ fashion regardless of size, shape, co-existing ulcer, and location. Several knives for endoscopic submucosal dissection are available and each of them has some merits and demerits. In this lecture, Dr. Yahagi presents his experience in ESD for GI tumors using dual knife.

In this lecture, Professor Didier Mutter, MD, PhD, FACS, explains the importance of collaboration between surgeons and endoscopists to improve combined minimally invasive techniques.

Endoscopic ultrasound (EUS) is useful for detecting depth of invasion and nodal involvement in patients with early Barrett's neoplasia. In this lecture, Dr. Bories presents the different aspects of EUS staging.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are commonly accepted methods for the resection of early neoplastic lesions in the upper and lower gastrointestinal tract. In this lecture, Dr. Inoue presents a new combined endoscopic and laparoscopic approach for gastric lesions, the CLEAN-NET.

This is an interesting and comprehensive lecture in which Professor Jung presents the endoscopic features of esophageal, gastric, and colorectal cancer, the different classifications and reports from conferences.

We present the live case showing the management of a large collection in the context of a past surgical history of splenectomy and pancreatic fistula. The 13cm diameter collection was drained internally by means of an endoscopic ultrasound-guided placement of a metallic stent.

In this authoritative lecture, Dr. Chung outlines the common indications of EMR, ESD, and the role of endoscopic full-thickness resection (EFTR) of digestive lesions.

Radiofrequency ablation of the entire metaplastic mucosa is recommended after the resection of neoplastic lesions with a curative intent (to avoid recurrences) or as first-line treatment in case of dysplasia without visible lesion. In this key lecture, Dr. Lepilliez presents technical aspects, indications and contraindications related to this technique.

The benefits of EMR and ESD overrule the complications associated with the procedures. Bleeding, perforations, and submucosal fibrosis are the most common complications encountered during resections.
The risk of bleeding (5-8%) and perforations (

Colorectal polyps are the most common type of polyps. Early resection before the polyp undergoes malignant transformation is key to long-term survival and to a favorable prognosis.
Endoscopic submucosal dissection (ESD) has been developed based on endoscopic mucosal resection (EMR) techniques. ESD can be used to resect lesions regardless of size, location, and fibrosis.

Indications for ESD:
- colorectal tumors when EMR is not feasible;
- tumors >20mm in size;
- lateral spreading tumors (non-granular) type;
- lateral spreading tumors (granular type) with a nodule;
- residual and recurrent tumors.

Technique:
- to accurately define the margins;
- to mark the borders;
- to perform a circumferential incision;
- to perform a submucosal dissection.

Complications:
- perforations – 2.4% in colonic ESD;
- bleeding – may be immediate or delayed, occurring after the procedure.
The overall rate of complications is 1.5%.

Endoscopic ultrasound (EUS):
The use of high-frequency EUS is useful to determine the depth of invasion of colorectal lesions. According to some studies, the efficacy of EUS is found to be superior to chromoendoscopy in determining the depth of the tumor.