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Novel articulating through-the-scope traction device
Endoscopic submucosal dissection (ESD) has become a standard approach for treating superficial GI neoplasia, but its adoption remains limited because of its steep learning curve and extensive resource utilization when performed by endoscopists in the earlier stages of the ESD learning curve.1,2 Furthermore, although traction strategy has emerged to improve clinical outcomes and increase procedural efficiency, current techniques and devices own inherent limitations such as technical complexity, lack of adjustability, or demanding preparation.Endoscopic reduction of type IV paraesophageal hernia
Type IV paraesophageal hernias are characterized by upward dislocation of the intra-abdominal organs into the thoracic cavity and the presence of a structure other than the stomach within the hernia sac. Although surgical repair is traditionally indicated in symptomatic patients with a paraesophageal hernia, limited options are available for patients deemed to be high risk for surgical repair.1,2 In this video (Video 1, available online at VideoGIE.org ), we describe a successful case of endoscopic type IV paraesophageal hernia reduction in a patient who was not able to undergo surgical repair.Endoscopic revision of gastric bypass using plication technique: an adjustable approach
Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric surgeries worldwide.1 Despite successful weight loss after RYGB, weight regain in subsequent years is common, with nearly one-third of patients returning to their prebypass weight.2,3 Although the cause of weight regain is often multifactorial, one of the anatomic causes is dilation and increased tissue compliance of the gastrojejunal anastomosis (GJA),4 which is likely a larger contributor to weight loss than anastomosis size alone.Emerging therapies in translational endoscopy: new frontiers in endoscopic submucosal dissection
The field of therapeutic endoscopy is evolving with a variety of new endoscopic surgical procedures. One such procedure, endoscopic submucosal dissection (ESD), has proven efficacy, yielding high margin-negative (R0) resection rates with low rates of adverse events and recurrence.1 However, the technical complexity, long procedure duration, and steep learning curve associated with ESD have led to relatively slow adoption. Although there has been an increased trend in devices and tools that may assist with ESD, there remains a paucity of advances in endoscopic technology, which are much needed given these known barriers.Making the transition from endoscopic submucosal dissection fellowship to independent practice: successful ESD of a large near-circumferential rectal lesion
Widespread adoption of endoscopic submucosal dissection (ESD) in the United States has been challenging, partly because of the limited availability of training opportunities.1 Recently, a junior faculty member based in the United States completed a novel 1-year ESD training program within a traditional American Society for Gastrointestinal Endoscopy fourth-year advanced endoscopy fellowship.2 During the course of the training program, the trainee had assisted with or observed 19 cases, partially performed 18 cases, and fully or mainly performed 26 cases, in which the mean lesion diameter was 44.5 mm and in which 79.2% of lesions were colorectal.Sleeve in sleeve: endoscopic revision for weight regain after sleeve gastrectomy
Sleeve gastrectomy (SG) is currently the most commonly performed bariatric surgical procedure in the United States.1 Although SG is effective at inducing weight loss and improving obesity-related comorbidities, weight regain is common. Approximately 5.7% of SG patients experience weight regain at 2 years, and this number increases to 75.6% at 6 years.2,3 At 7 years, approximately 19.9% of SG patients undergo surgical revision.4Robotic-assisted surgical endoscopy: a new era for endoluminal therapies
Minimally invasive endoscopic procedures are associated with lower adverse events and shorter hospital stays compared with conventional open surgery.1,2 However, some advanced endoscopic procedures, including endoscopic submucosal dissection (ESD), natural orifice transluminal endoscopic surgery (NOTES), and suturing, have typically required specialized training and a certain amount of experience to achieve competency. Therefore, these procedures are not widely performed in nonspecialized centers.Subpyloric tunneling endoscopic submucosal dissection: a novel technique for safe and successful removal of a challenging duodenal submucosal lesion
Owing to their anatomic location, submucosal lesions in the proximal duodenal bulb can be challenging to resect by EMR. Here, we present a novel endoscopic submucosal dissection (ESD) technique for successful removal of a duodenal submucosal lesion (Video 1, available online at www.VideoGIE.org ).Multi-bypass with the use of lumen-apposing metal stents to maintain luminal continuity of the GI tract in a patient with altered anatomy
The goal of endoscopic palliative therapies is to provide improvement in quality of life with minimal morbidity and mortality. Surgery has been the primary treatment for malignant obstruction, although surgical morbidity is higher in emergency scenarios. Stent placement is commonly used in malignant and benign GI obstruction with established efficacy and safety.1,2 Lumen-apposing metal stents (LAMSs) represent an evolution in endoscopic stents and are considered a disruptive change in therapeutic endoscopy.Use of a cardiac septal occluder in the treatment of a chronic GI fistula: What should we know before off-label use in the GI tract?
A GI fistula is defined as an abnormal communication between 2 epithelialized surfaces, which can be characterized as internal (between 2 abdominal organs) or external (between an abdominal organ and the body surface). The most common causes of GI fistulas include postoperative adverse events, longstanding untreated leaks, chronic inflammatory conditions, malignancy, and radiation therapy.1,2Endoscopic tunneled stricturotomy in the treatment of stenosis after sleeve gastrectomy
Obesity is a worldwide pandemic, and bariatric surgery is the most effective method used to treat this disease. Laparoscopic sleeve gastrectomy (LSG) is rapidly becoming the most commonly performed bariatric surgery because it is perceived as being the “easier technique.” Despite clinical efficacy, adverse events have gradually increased because of its broad adoption.1-3Gastric plications for weight loss: distal primary obesity surgery endoluminal through a belt-and-suspenders approach
A 40-year-old woman with lifelong obesity presented for consultation regarding a weight-loss procedure. Despite trying several weight-loss programs, she had been able to lose only 10 to 15 pounds and was unable to maintain this weight loss. Her medical history included polycystic ovary syndrome, hyperlipidemia, gallstone disease, and cholecystectomy. Her family history was notable for obesity, type 2 diabetes, and hypertension. Her physical examination results were notable for a weight of 228 pounds, height of 62 inches, and body mass index of 41.7 kg/m2.Successful removal of duodenal submucosal tumors with endoscopic submucosal dissection
Endoscopic submucosal dissection (ESD) in the duodenal bulb is technically challenging because of the thin wall and perpendicular angulation of the duodenum. However, ESD allows for the en bloc resection of both mucosal and submucosal lesions, which may theoretically allow for lower recurrence rates. We present 2 cases of ESD for resection of submucosal neoplasms in the duodenal bulb, and we highlight techniques and strategies for successful resection (Video 1, available online at www.VideoGIE.org ).
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