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Endoscopic surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.


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Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing metal stent
This video demonstrates a case of EUS-guided choledochoduodenostomy, emblematic of the latest cutting-edge technology.
A 86-year-old woman with recent abdominal pain and jaundice underwent a CT-scan, which showed an enlarged tumor of the second portion of the duodenum with biliary tree dilatation. Gastroscopy with biopsy confirmed the diagnosis of duodenal adenocarcinoma of the 2nd duodenum.
First, endoscopic retrograde cholangiopancreatography (ERCP) failed to achieve biliary drainage because of an inability to cannulate the papilla due to tumor infiltration. EUS-guided hepatogastrostomy (EUS-HGS) was not attempted because the left intra-hepatic bile ducts were minimally dilated (3mm). However, the common bile duct (CBD) was largely dilated (20 mm). A Hot AXIOS™ Stent and Electrocautery Enhanced Delivery System (stent of 8 by 6mm) was advanced through the bulb. Pure cut electrocautery current was then applied, allowing the device to reach the CBD. Next, the distal flange was opened and retracted towards the EUS transducer, and once a biliary and bulbar tissue apposition had been noted, the proximal flange was released. Good drainage of purulent bile was observed and no complications occurred during the procedure and one month afterwards.
A Sportes, G Airinei, R Kamel, R Benamouzig
Surgical intervention
6 months ago
220 views
6 likes
0 comments
03:09
Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing metal stent
This video demonstrates a case of EUS-guided choledochoduodenostomy, emblematic of the latest cutting-edge technology.
A 86-year-old woman with recent abdominal pain and jaundice underwent a CT-scan, which showed an enlarged tumor of the second portion of the duodenum with biliary tree dilatation. Gastroscopy with biopsy confirmed the diagnosis of duodenal adenocarcinoma of the 2nd duodenum.
First, endoscopic retrograde cholangiopancreatography (ERCP) failed to achieve biliary drainage because of an inability to cannulate the papilla due to tumor infiltration. EUS-guided hepatogastrostomy (EUS-HGS) was not attempted because the left intra-hepatic bile ducts were minimally dilated (3mm). However, the common bile duct (CBD) was largely dilated (20 mm). A Hot AXIOS™ Stent and Electrocautery Enhanced Delivery System (stent of 8 by 6mm) was advanced through the bulb. Pure cut electrocautery current was then applied, allowing the device to reach the CBD. Next, the distal flange was opened and retracted towards the EUS transducer, and once a biliary and bulbar tissue apposition had been noted, the proximal flange was released. Good drainage of purulent bile was observed and no complications occurred during the procedure and one month afterwards.
Large intradiverticulum endoscopic biliary sphincterotomy
Periampullary duodenal diverticula are observed in 10-20% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and could well increase ampulla cannulation failure risk, as well as potential complications related to endoscopic sphincterotomy.
Here we report two successful cases of large intradiverticular endoscopic biliary sphincterotomy in the treatment of two different kinds of benign biliary pathologies. The first case was that of a woman with multiple large stones in the common bile duct (CBD). The second case was one of a male patient with cholestasis due to a compression of the distal common bile duct caused by a diverticulum – this condition being known as Lemmel’s syndrome.
Gf Donatelli, L Marx, J Marescaux
Surgical intervention
1 year ago
1325 views
77 likes
0 comments
05:09
Large intradiverticulum endoscopic biliary sphincterotomy
Periampullary duodenal diverticula are observed in 10-20% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and could well increase ampulla cannulation failure risk, as well as potential complications related to endoscopic sphincterotomy.
Here we report two successful cases of large intradiverticular endoscopic biliary sphincterotomy in the treatment of two different kinds of benign biliary pathologies. The first case was that of a woman with multiple large stones in the common bile duct (CBD). The second case was one of a male patient with cholestasis due to a compression of the distal common bile duct caused by a diverticulum – this condition being known as Lemmel’s syndrome.
LIVE INTERACTIVE SURGERY: Endoscopic Submucosal Dissection (ESD) for colonic polyp
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.
N Fukami
Surgical intervention
2 years ago
747 views
32 likes
0 comments
32:29
LIVE INTERACTIVE SURGERY: Endoscopic Submucosal Dissection (ESD) for colonic polyp
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.
LIVE INTERACTIVE SURGERY: Colonoscopy and resection of large pedunculated sigmoid colon polyp
An intestinal polyp is a mass of tissue, which arises from the bowel wall and protrudes into the lumen. Polyps may be sessile or pedunculated. The incidence of polyps ranges from 7 to 50%. Polyps are most commonly found in the rectum and sigmoid colon and decrease in frequency towards the caecum.
Symptoms and signs:
Polyps are usually asymptomatic. The most frequent complaint is rectal bleeding, which is usually occult. Abdominal pain and obstruction occur with large polyps. The main concern with polyps is the risk of malignant transformation.
Complications of polypectomy: Common complications following polypectomy are bleeding and infection. The risk of bleeding ranges from 0.2 to 1.2%. When patients are on blood thinners, the risk of bleeding increases to 6.8%.
Advantages and disadvantages of use of prophylactic clips:
Clips can be applied during the procedure itself. They are easy to deploy. No scarring can be observed.
Disadvantages:
They are expensive, and present a risk of perforation and further bleeding.
R Dumas, S Leblanc
Surgical intervention
2 years ago
1055 views
39 likes
0 comments
11:52
LIVE INTERACTIVE SURGERY: Colonoscopy and resection of large pedunculated sigmoid colon polyp
An intestinal polyp is a mass of tissue, which arises from the bowel wall and protrudes into the lumen. Polyps may be sessile or pedunculated. The incidence of polyps ranges from 7 to 50%. Polyps are most commonly found in the rectum and sigmoid colon and decrease in frequency towards the caecum.
Symptoms and signs:
Polyps are usually asymptomatic. The most frequent complaint is rectal bleeding, which is usually occult. Abdominal pain and obstruction occur with large polyps. The main concern with polyps is the risk of malignant transformation.
Complications of polypectomy: Common complications following polypectomy are bleeding and infection. The risk of bleeding ranges from 0.2 to 1.2%. When patients are on blood thinners, the risk of bleeding increases to 6.8%.
Advantages and disadvantages of use of prophylactic clips:
Clips can be applied during the procedure itself. They are easy to deploy. No scarring can be observed.
Disadvantages:
They are expensive, and present a risk of perforation and further bleeding.
Staging before endoscopic resection: EMR and ESD
Pre-procedural planning before any endoscopic resection requires the assessment of the lesion. The main criteria which need to be assessed are the following:
- depth of invasion of the lesion;
- lymph node metastasis;
- lateral spread of the tumor;
- pit pattern.
Routine endoscopy is used to assess tumor size. Tumors can be staged with the use of many classifications, and notably the Paris classification.
High-frequency (≥20MHz) endoscopic ultrasonography (EUS) produces an image of the mucosal wall comprising nine separate layers differentiated by their echogenicity. Careful examination of the depth of lesion penetration into the mucosal and submucosal layers is used to determine the risk of lymph node metastases with a greater precision.
Pit pattern can be evaluated by means of magnification on endoscopy.
Kudos classification is used.
Type I: roundish pits
Type II: stellar or papillary pits
Type III S: small roundish or tubular pits (smaller than type I pits)
Type III L: large roundish or tubular pits (larger than type I pits)
Type IV: branch-like or gyrus-like pits
Type V: non-structured pits
M Barthet
Lecture
2 years ago
298 views
13 likes
0 comments
16:59
Staging before endoscopic resection: EMR and ESD
Pre-procedural planning before any endoscopic resection requires the assessment of the lesion. The main criteria which need to be assessed are the following:
- depth of invasion of the lesion;
- lymph node metastasis;
- lateral spread of the tumor;
- pit pattern.
Routine endoscopy is used to assess tumor size. Tumors can be staged with the use of many classifications, and notably the Paris classification.
High-frequency (≥20MHz) endoscopic ultrasonography (EUS) produces an image of the mucosal wall comprising nine separate layers differentiated by their echogenicity. Careful examination of the depth of lesion penetration into the mucosal and submucosal layers is used to determine the risk of lymph node metastases with a greater precision.
Pit pattern can be evaluated by means of magnification on endoscopy.
Kudos classification is used.
Type I: roundish pits
Type II: stellar or papillary pits
Type III S: small roundish or tubular pits (smaller than type I pits)
Type III L: large roundish or tubular pits (larger than type I pits)
Type IV: branch-like or gyrus-like pits
Type V: non-structured pits
Video case: colon cancer
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.
R Dumas
Lecture
2 years ago
1039 views
41 likes
0 comments
11:03
Video case: colon cancer
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.
Respective indications of EMR and ESD
Endoscopy has increased the detection of early neoplastic lesions of the gastrointestinal tract (GIT) known as gastrointestinal superficial lesions.
Endoscopic resection is adequate in patients with early gastrointestinal cancer with limited or completely nil submucosal involvement. Endoscopic resections are mainly used for high- and low-grade dysplasia. Most lesions can be treated using endoscopic mucosal resection (EMR), however unsuitable for lesions greater than 20mm in size. Endoscopic submucosal dissection (ESD) allows to achieve an ‘en bloc’ resection of the lesions, irrespective of the size of the tumor.
Esophagus:
Endoscopic resection is indicated for esophageal cancers with no risk of lymph node invasion. The size of the lesion is the main criterion for the choice of the procedure.
Barrett’s esophagus: EMR is the gold standard for endoscopic excision in Barrett’s esophagus; the main limitation is piecemeal resection with EMR, which makes histopathological assessment difficult, and the risk of recurrence and residual tumor is high. ESD should be considered for lesions greater than 15mm, poorly lifting tumors, and those at risk for submucosal invasion.
Stomach:
The lesions which should be considered for endoscopic resection because of a very low risk of lymph node metastasis are the following:
- non-invasive neoplasia (dysplasia) independently of size;
- intramucosal differentiated-type adenocarcinoma, without ulceration (size ≤2cm absolute indication, >2cm expanded indication);
- intramucosal differentiated-type adenocarcinoma, with ulcer, size ≤3cm (expanded indication);
- intramucosal undifferentiated-type adenocarcinoma, size ≤2cm (expanded indication);
- differentiated-type adenocarcinoma with superficial submucosal invasion.
EMR was the first treatment alternative to surgery for early gastric cancer. However, EMR is associated with a high recurrence rate (30%) according to some studies.
ESD for early gastric cancers has higher ‘en bloc’ resection rates, histologically complete resection rates, and low recurrence rates. ESD though is associated with longer operative times.
Duodenum:
The use of endoscopic resection in the duodenum and the small bowel is limited because of a high risk of perforations. EMR standard or piecemeal resections can be used for superficial lesions with perforation rates less than 5%.
Colon:
EMR represents a highly effective treatment for lesions of the colon less than 20mm in diameter. Piecemeal EMR for larger lesions reduces the quality and reliability of histopathological findings.
In the rectum, the indications for ESD may be extended for all large (>20mm), non-granular (NG) or granular lesions, or mixed laterally spreading tumors (LSTs) (>20-30mm).
ESD can be considered for the removal of colonic and rectal lesions with a high suspicion of limited submucosal invasion, which is based on two main criteria, namely a depressed morphology and an irregular or non-granular surface pattern, particularly if the lesions are larger than 20 mm.
Summary:
EMR should be the first option for the following:
- superficial lesion in Barrett’s esophagus;
- small gastric lesion
N Fukami
Lecture
2 years ago
407 views
21 likes
0 comments
29:26
Respective indications of EMR and ESD
Endoscopy has increased the detection of early neoplastic lesions of the gastrointestinal tract (GIT) known as gastrointestinal superficial lesions.
Endoscopic resection is adequate in patients with early gastrointestinal cancer with limited or completely nil submucosal involvement. Endoscopic resections are mainly used for high- and low-grade dysplasia. Most lesions can be treated using endoscopic mucosal resection (EMR), however unsuitable for lesions greater than 20mm in size. Endoscopic submucosal dissection (ESD) allows to achieve an ‘en bloc’ resection of the lesions, irrespective of the size of the tumor.
Esophagus:
Endoscopic resection is indicated for esophageal cancers with no risk of lymph node invasion. The size of the lesion is the main criterion for the choice of the procedure.
Barrett’s esophagus: EMR is the gold standard for endoscopic excision in Barrett’s esophagus; the main limitation is piecemeal resection with EMR, which makes histopathological assessment difficult, and the risk of recurrence and residual tumor is high. ESD should be considered for lesions greater than 15mm, poorly lifting tumors, and those at risk for submucosal invasion.
Stomach:
The lesions which should be considered for endoscopic resection because of a very low risk of lymph node metastasis are the following:
- non-invasive neoplasia (dysplasia) independently of size;
- intramucosal differentiated-type adenocarcinoma, without ulceration (size ≤2cm absolute indication, >2cm expanded indication);
- intramucosal differentiated-type adenocarcinoma, with ulcer, size ≤3cm (expanded indication);
- intramucosal undifferentiated-type adenocarcinoma, size ≤2cm (expanded indication);
- differentiated-type adenocarcinoma with superficial submucosal invasion.
EMR was the first treatment alternative to surgery for early gastric cancer. However, EMR is associated with a high recurrence rate (30%) according to some studies.
ESD for early gastric cancers has higher ‘en bloc’ resection rates, histologically complete resection rates, and low recurrence rates. ESD though is associated with longer operative times.
Duodenum:
The use of endoscopic resection in the duodenum and the small bowel is limited because of a high risk of perforations. EMR standard or piecemeal resections can be used for superficial lesions with perforation rates less than 5%.
Colon:
EMR represents a highly effective treatment for lesions of the colon less than 20mm in diameter. Piecemeal EMR for larger lesions reduces the quality and reliability of histopathological findings.
In the rectum, the indications for ESD may be extended for all large (>20mm), non-granular (NG) or granular lesions, or mixed laterally spreading tumors (LSTs) (>20-30mm).
ESD can be considered for the removal of colonic and rectal lesions with a high suspicion of limited submucosal invasion, which is based on two main criteria, namely a depressed morphology and an irregular or non-granular surface pattern, particularly if the lesions are larger than 20 mm.
Summary:
EMR should be the first option for the following:
- superficial lesion in Barrett’s esophagus;
- small gastric lesion
How to manage EMR/ESD resection specimen for accurate histological assessment
In this lecture, Dr. Lehr outlines the various methods of handling the resected specimens. The importance of ‘en bloc’ resection over piecemeal resection is highlighted. ESD specimens are usually resected ‘en bloc’, hence 82% of the resections are R0, and the risk of recurrence is less than 1%.
As for EMR, 48% of specimens are piecemeal. Consequently, an accurate assessment of the resection margin cannot be achieved and the risk of recurrence is greater than 6%.
The true depth of the tumor can only be assessed when the lesion is resected in one piece and with the avoidance of electrocautery injuries inside or at the edges of the lesion. The specimen must be fixed on a Styrofoam or in specialized boxes to prevent it from curling up once put in formalin.
Specimen orientation is essential in order to help the pathologist for proper examination and reporting.
HA Lehr
Lecture
2 years ago
134 views
5 likes
0 comments
22:13
How to manage EMR/ESD resection specimen for accurate histological assessment
In this lecture, Dr. Lehr outlines the various methods of handling the resected specimens. The importance of ‘en bloc’ resection over piecemeal resection is highlighted. ESD specimens are usually resected ‘en bloc’, hence 82% of the resections are R0, and the risk of recurrence is less than 1%.
As for EMR, 48% of specimens are piecemeal. Consequently, an accurate assessment of the resection margin cannot be achieved and the risk of recurrence is greater than 6%.
The true depth of the tumor can only be assessed when the lesion is resected in one piece and with the avoidance of electrocautery injuries inside or at the edges of the lesion. The specimen must be fixed on a Styrofoam or in specialized boxes to prevent it from curling up once put in formalin.
Specimen orientation is essential in order to help the pathologist for proper examination and reporting.
High-definition endoscopy and chromoendoscopy
Chromoendoscopy uses the topical application of stains or pigments to improve tissue localization, characterization, or diagnosis during endoscopy. Various stains used are as follows:
- absorptive stains: Lugol’s solution of iodine, methylene blue;
- contrast stains: indigo carmine;
- reactive stains: congo red and phenol red.
The most commonly used stains are iodine and methylene blue.
The other available advanced endoscopic technologies for lesion assessment are magnification endoscopy, confocal endoscopy, and confocal endocytoscopy. This video highlights the various types of mucosal patterns in early cancer seen with the use of high definition and magnification endoscopy.
Narrow band imaging (NBI): this is an imaging technique used in endoscopy where lights of blue or green wavelength are used to enhance the details of the mucosal pattern.
H Minami
Lecture
2 years ago
399 views
14 likes
0 comments
16:19
High-definition endoscopy and chromoendoscopy
Chromoendoscopy uses the topical application of stains or pigments to improve tissue localization, characterization, or diagnosis during endoscopy. Various stains used are as follows:
- absorptive stains: Lugol’s solution of iodine, methylene blue;
- contrast stains: indigo carmine;
- reactive stains: congo red and phenol red.
The most commonly used stains are iodine and methylene blue.
The other available advanced endoscopic technologies for lesion assessment are magnification endoscopy, confocal endoscopy, and confocal endocytoscopy. This video highlights the various types of mucosal patterns in early cancer seen with the use of high definition and magnification endoscopy.
Narrow band imaging (NBI): this is an imaging technique used in endoscopy where lights of blue or green wavelength are used to enhance the details of the mucosal pattern.
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
963 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
419 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
369 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.
Endoscopic biliary stones extraction using a forward viewing standard gastroscope in a patient with altered anatomy (partial gastrectomy with Billroth II reconstruction)
Endoscopic retrograde cholangiography in case of altered anatomy such as partial gastrectomy with Billroth II reconstruction has a success rate of 85% due to different factors such as failure to cross the anastomosis and the presence of an important length of afferent loop with a high risk of jejunal perforation at (or near) the anastomotic site while advancing the duodenoscope. The use of a front-view scope is the safest and could be used theoretically. However, the lack of elevator, the inability to see the papilla in a direct view, and the limited number of catheters available for cannulation and therapeutic procedures in the standard gastroscope with the 2.8mm working channel, can make this kind of procedure quite challenging. In this video, we present a case of successful biliary stone extraction in a patient with Billroth II reconstruction using a standard 2.8mm working channel front-viewing scope.
Gf Donatelli, BM Vergeau, B Meduri
Surgical intervention
3 years ago
842 views
14 likes
0 comments
04:47
Endoscopic biliary stones extraction using a forward viewing standard gastroscope in a patient with altered anatomy (partial gastrectomy with Billroth II reconstruction)
Endoscopic retrograde cholangiography in case of altered anatomy such as partial gastrectomy with Billroth II reconstruction has a success rate of 85% due to different factors such as failure to cross the anastomosis and the presence of an important length of afferent loop with a high risk of jejunal perforation at (or near) the anastomotic site while advancing the duodenoscope. The use of a front-view scope is the safest and could be used theoretically. However, the lack of elevator, the inability to see the papilla in a direct view, and the limited number of catheters available for cannulation and therapeutic procedures in the standard gastroscope with the 2.8mm working channel, can make this kind of procedure quite challenging. In this video, we present a case of successful biliary stone extraction in a patient with Billroth II reconstruction using a standard 2.8mm working channel front-viewing scope.
Principles of tubal surgery
This presentation focuses on the specific advantages of tubal surgery as compared to assisted reproductive techniques (ART).
Tubal surgery is a valid option in selected cases.
This selection is only possible through endoscopy and a precise knowledge of lesions is necessary. Three kinds of lesions have to be precisely known: pelvic adhesions and tubal lesions, either distal or proximal.
Nowadays, a special focus has to be made on subtle tubal lesions which were underestimated until recently.
Diagnosis and patient selection is a key factor and it is best achieved through transvaginal endoscopy such as fertiloscopy.
Even if today laparoscopy is the gold standard to treat tubal abnormalities, the principles of microsurgery which were defined a long time ago have to be strictly applied if one wants to get a pregnancy rate equivalent or superior to what is expected with in vitro fertilization (IVF).
A Watrelot
Lecture
3 years ago
1649 views
77 likes
0 comments
16:07
Principles of tubal surgery
This presentation focuses on the specific advantages of tubal surgery as compared to assisted reproductive techniques (ART).
Tubal surgery is a valid option in selected cases.
This selection is only possible through endoscopy and a precise knowledge of lesions is necessary. Three kinds of lesions have to be precisely known: pelvic adhesions and tubal lesions, either distal or proximal.
Nowadays, a special focus has to be made on subtle tubal lesions which were underestimated until recently.
Diagnosis and patient selection is a key factor and it is best achieved through transvaginal endoscopy such as fertiloscopy.
Even if today laparoscopy is the gold standard to treat tubal abnormalities, the principles of microsurgery which were defined a long time ago have to be strictly applied if one wants to get a pregnancy rate equivalent or superior to what is expected with in vitro fertilization (IVF).
Single stage diagnosis and treatment by EUS and ERCP of a pancreatic stone causing an acute pancreatitis
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.
Gf Donatelli, B Meduri
Surgical intervention
3 years ago
1131 views
41 likes
0 comments
05:10
Single stage diagnosis and treatment by EUS and ERCP of a pancreatic stone causing an acute pancreatitis
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.
Endoscopic internal drainage (EID) for leaks following sleeve gastrectomy
Leaks following sleeve gastrectomy represent a serious problem for surgeons, since a standardized approach has not yet been established.
Usually laparoscopic exploration is necessary in order to achieve a diagnostic peritoneal lavage, and a surgical drain is left in place proximally to the suture line, at the level of the dehiscence (if visualized), jejunostomy is also frequently performed to ensure enteral alimentation. This treatment however, needs to be combined with an endoscopic treatment, in order to facilitate rapid closure of gastric staple line defects.
In this video we report our Endoscopic Internal Drainage (EID) technique by insertion of double pigtail stents combined for the firsts weeks with enteral nutrition, with the aim to create an internal fistula allowing to quickly remove the surgical drain, and promote the formation of granulation tissue at the level of the dehiscence.
Reference:
Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Obes Surg 2014;24:1400-7.
Gf Donatelli
Surgical intervention
4 years ago
897 views
22 likes
0 comments
06:33
Endoscopic internal drainage (EID) for leaks following sleeve gastrectomy
Leaks following sleeve gastrectomy represent a serious problem for surgeons, since a standardized approach has not yet been established.
Usually laparoscopic exploration is necessary in order to achieve a diagnostic peritoneal lavage, and a surgical drain is left in place proximally to the suture line, at the level of the dehiscence (if visualized), jejunostomy is also frequently performed to ensure enteral alimentation. This treatment however, needs to be combined with an endoscopic treatment, in order to facilitate rapid closure of gastric staple line defects.
In this video we report our Endoscopic Internal Drainage (EID) technique by insertion of double pigtail stents combined for the firsts weeks with enteral nutrition, with the aim to create an internal fistula allowing to quickly remove the surgical drain, and promote the formation of granulation tissue at the level of the dehiscence.
Reference:
Endoscopic internal drainage with enteral nutrition (EDEN) for treatment of leaks following sleeve gastrectomy. Donatelli G, Ferretti S, Vergeau BM, Dhumane P, Dumont JL, Derhy S, Tuszynski T, Dritsas S, Carloni A, Catheline JM, Pourcher G, Dagher I, Meduri B. Obes Surg 2014;24:1400-7.
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Gf Donatelli, P Dhumane, S Perretta, BM Vergeau, JL Dumont, T Tuszynski, B Meduri
Surgical intervention
4 years ago
857 views
13 likes
0 comments
04:09
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.