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The Gastroenterology & Endoscopy Podcast
Episode 147: Endoscopic Management of Premalignant Lesions
Quick Summary:
An evidence-based overview of EMR vs ESD for premalignant lesions, including technique selection, outcomes, and complication rates.
Key Points:
• EMR: Preferred for lesions <15mm, 0.5-1% perforation risk
• ESD: Better for lesions >20mm, 83-98% en bloc resection rate
• Technique selection based on lesion size, location, and suspected invasion
• Watch for delayed bleeding and stricture formation
Essential Reading:
1. ASGE Guidelines on ESD
https://www.asge.org/docs/default-source/guidelines/asge-guideline-on-endoscopic-submucosal-dissection
2. Cleveland Clinic EMR Protocol
https://my.clevelandclinic.org/health/treatments/21148-endoscopic-mucosal-resection
3. Mayo Clinic ESD Guide
https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/esophageal-endoscopic-submucosal-dissection/mac-20552628
Additional Resources:
• Clinical Outcomes Study - https://www.sciencedirect.com/science/article/abs/pii/S0016510712023760
• ESD Technical Analysis - https://pmc.ncbi.nlm.nih.gov/articles/PMC3072634/
• Comparative Review - https://pmc.ncbi.nlm.nih.gov/articles/PMC5824597/
• Technical Developments - https://www.sciencedirect.com/science/article/abs/pii/S0960740422000354https://www.gastroendopod.com
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In this episode of the GI Endoscopy Update Podcast, Dr. Sarah Thompson explores the latest advancements in artificial intelligence (AI) for gastrointestinal endoscopy. Key topics include:
Recent breakthroughs in video capsule endoscopyAI applications in colonoscopy and lesion characterizationAdvancements in esophageal neoplasia detectionBenefits of AI integration in endoscopic practiceChallenges and limitations of AI implementationFuture prospects for AI in GI endoscopyKey takeaways:
AI significantly improves diagnosis accuracy and efficiencyChallenges include over-reliance risks and technical limitationsFuture developments may include integration with EHRs and personalized medicineSources and Resources:
Ding et al. (Study on AI software for small-bowel abnormalities diagnosis)Zhang et al. (Research on magnetically guided capsule for gastric diagnosis)Mori et al. (Algorithms for colonoscopy image analysis)Hossain et al. (Study on AI in lesion characterization)Everson et al. (Research on AI for esophageal neoplasia detection)Medtronic and Modernizing Medicine collaboration (Integration of AI with EHR systems)https://www.gastroendopod.com
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Saknas det avsnitt?
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Join us for a deep dive into the cutting-edge world of polyp reshaping in colonoscopy. In this episode of The Gastroenterology & Endoscopy Podcast, we explore how these advanced techniques are transforming colorectal cancer prevention.
The Evolution of Polyp ManagementFrom "detect and excise" to a nuanced, multifaceted approachBalancing precision, risk minimization, and colonic function preservationCornerstones of Effective Polyp ReshapingAdvanced classification systems: Paris classification and beyondCutting-edge imaging techniques: NBI, CLE, and pit pattern evaluationThe importance of size stratification and location considerationsRevolutionary Reshaping TechniquesEndoscopic Mucosal Resection (EMR): Injection-assisted, cap-assisted, and underwater variantsEndoscopic Submucosal Dissection (ESD): Achieving en bloc removal of large lesionsFull-Thickness Resection (EFTR): Tackling lesions involving the muscularis propriaThe Future is Now: Emerging TechnologiesArtificial Intelligence in polyp detection and characterizationAdvanced imaging: Optical coherence tomography and molecular imagingInnovative devices: From microwave ablation to biodegradable clipsPersonalized Approach to Technique SelectionConsidering lesion-specific factors, patient profiles, and endoscopist expertiseThe role of multidisciplinary tumor boards in complex casesPost-Resection Care and Long-Term SuccessPrecision histopathology and risk-stratified surveillanceManaging complications with cutting-edge solutionsChallenges and Future DirectionsStandardization of quality metricsThe promise of multi-omics data integrationEthical considerations in AI implementation
Key Topics:Why Listen:
Gain insights into state-of-the-art polyp management techniquesUnderstand how these advancements are improving patient outcomesLearn about the future of endoscopic interventions in colorectal cancer preventionExpert Insight: "Every reshaped polyp represents a potential life saved, bringing us closer to a world where colorectal cancer is no longer a leading cause of cancer-related mortality."Resources Mentioned:
Paris classification system for polyp morphologyKudo's classification for pit pattern evaluationNarrow-band imaging (NBI) and confocal laser endomicroscopy (CLE)Polyp Reshaping in Colonoscopy
https://www.gastroendopod.com
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Welcome to our podcast on endoscopic resection of Zenker's diverticulum. Today, we'll dive deep into this condition, its treatment, and the benefits of endoscopic approaches.
Zenker's diverticulum is a rare disorder of the esophagus, primarily affecting elderly individuals between their 70s and 90s. It's more common in men and occurs in about 0.01% to 0.11% of the population, with higher rates in northern Europe, the United States, and Canada[1].
This condition involves a pouch forming in the hypopharynx, typically between the cricopharyngeus (CP) muscle and the inferior pharyngeal constrictor muscle. It's a false diverticulum, meaning it only involves the mucosa and submucosal layers, not the muscular layer[1].
The exact cause isn't fully understood, but it's believed to result from abnormal pressure during swallowing, causing a weakness in the Killian triangle - the area between the horizontal and oblique fibers of the cricopharyngeus muscle[1].
Patients typically present with a long history of dysphagia, or difficulty swallowing, which occurs in up to 98% of cases. Other common symptoms include regurgitation, halitosis, aspiration, and recurrent coughing[1].
Traditionally, Zenker's diverticulum was treated with open surgery or rigid endoscopic techniques using a laryngoscope. However, these methods require general anesthesia, tracheal intubation, and are more invasive, leading to higher complication rates and longer hospital stays[2].
In recent years, flexible endoscopic treatment has emerged as a superior option. This approach offers several advantages:
1. It's less invasive, reducing patient discomfort.
2. It requires a shorter hospital stay, typically around 2 days.
3. Patients can resume oral food intake the day after treatment.
4. It has lower complication and mortality rates compared to traditional methods[2].
Now, let's discuss the key steps for performing an endoscopic resection:
1. Use of a transparent cap: This is attached to the endoscope tip. It stabilizes the view, maintains a safe distance from the tissue, and allows for precise incisions.
2. Ensuring clear visualization: The esophageal lumen and diverticulum should be clearly visible. If visibility is difficult, a guidewire or thin tube can be placed into the stomach to maintain a clear view of the esophagus.
3. Choosing the right tools: Various devices have been examined for this procedure. A hook knife is often preferred as it allows for controlled cutting and dissection of muscle fibers. Other options include argon plasma coagulation, different types of needles, stapling devices, and endoscopic scissors[3].
4. Performing the septotomy: This is done in stages. First, incise the mucosa, then the submucosa, and finally the muscle fibers. It's crucial to proceed slowly and steadily. The goal is to cut the cricopharyngeal muscle, which is the main objective of the treatment.
5. Safety closure: After dissecting to the base of the septum, place a closing clip at the apex of the dissection. This is the most vulnerable area for perforation. A clip with a short stem is preferred to avoid irritating the opposite wall.
It's important to note that this procedure is challenging and should be performed by endoscopists with high expertise in therapeutic endoscopy. It requires special training, which can be difficult to obtain due to the rarity of the condition[2].
The benefits of endoscopic treatment are significant. Patient satisfaction is reportedly very high, with patients appreciating the non-invasive nature, short hospital stay, and high rates of dysphagia resolution. Even in cases of symptom recurrence, the procedure can usually be repeated effectively[2].
In conclusion, endoscopic resection of Zenker's diverticulum represents ahttps://www.gastroendopod.com
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In this in-depth episode, we dive headfirst into one of the most polarizing topics in modern gastrointestinal medicine - the heated debate between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) techniques.
Cold Snare vs Hot Snare: Polypectomy Factshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506415/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10246601/https://www.gastroenterologyadvisor.com/colorectal-neoplasia/cold-vs-hot-snare-polypectomy-yields-more-favorable-outcomes-for-colorectal-polyps/
Our host provides a comprehensive overview of these two pivotal polyp removal methods, exploring their pros, cons, and appropriate use cases. We learn about:
• The fundamentals of CSP and HSP
• European guideline recommendations for each technique based on polyp size
• Comparative data on complete resection rates and complication profiles
• Managing challenges like bleeding and tissue injury
• The critical importance of polyp retrieval and histopathological analysis
• Potential future advancements in endoscopic tools and techniques
• Adhering to best practices and clinical guidelines
Key Takeaways:
- CSP shows a superior safety profile for diminutive (<5mm) and small (6-9mm) sessile polyps
- HSP provides coagulation benefits for larger polyps (10-20mm) and bleeding control
- Both methods demonstrate comparable resection completeness for 4-10mm polyps
- HSP carries higher risks like delayed bleeding and deep thermal injury
- Polyp retrieval quality is high with both techniques for accurate diagnosis
- Technique choice depends on balancing polyp factors and patient needs
- Ongoing research and new technologies will further refine polypectomy
Whether you're a seasoned endoscopist or just getting started, this episode provides invaluable insights into optimizing polypectomy outcomes through the judicious application of CSP and HSP. Join us as we unpack this critical clinical debate.
Links:https://www.gastroendopod.com
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The Couinaud classification is a vital tool in the field of hepatic surgery and diagnoses. It offers a comprehensive understanding of the functional anatomy of the liver by dividing it into eight independent segments. Unlike other classification systems, Couinaud classification focuses on the liver's functional aspects rather than its external appearance.
The Couinaud classification divides the liver into eight independent functional units called segments.The classification aids in precise surgical resections and accurate diagnoses.Each liver segment has its own dual vascular inflow, biliary drainage, and lymphatic drainage.The Couinaud classification is widely accepted and used in clinical practice.It is important for healthcare professionals involved in hepatic surgery, diagnoses, and radiology to understand and apply the Couinaud classification.
Key Takeaways:Couinaud's innovative approach to liver segmentation has become a cornerstone in modern hepatic surgery, guiding surgeons in planning and executing procedures with utmost accuracy. By preserving the functional integrity of individual liver segments, surgical resection can be performed with optimal outcomes, enhancing patient recovery and long-term prognosis.
https://www.gastroendopod.com
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Episode Overview
Discussion on the endoscopic resection of a laterally spreading tumor (LST) in the ascending colon.Examination of a flat polypoid lesion larger than 10 mm, classified as an LST.
Determining the Lesion's Location: Found between two folds.Analyzing Morphology: Identified as LST-granular.Surface Analysis: Using high-definition white light and narrow-band imaging, revealing a regular, cerebroid mucosal pit pattern without ulcers or depressions (Kudo IIIL).Maintaining Visibility: Employing a "suction" mark technique to keep track of the polyp.
Key Steps in Resection Planning
Comparison of "cold snare" and "hot snare" techniques.Preference for endoscopic resection using interventional chromoendoscopy.
Resection Techniques
Submucosal injection with a blue colorant to differentiate tissue types.The concept of using colorings to guide therapeutic interventions.
Interventional Chromoendoscopy
Using a snare to estimate lesion size and achieve complete entrapment.Achieving an endoscopic R0 resection by applying electrosurgical current.
Resection Process
Links:
https://www.thepracticingendoscopist.com/p/endoscopic-resection-of-lst-in-ascending-colon
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353652/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984535/
[3] https://www.linkedin.com/posts/klaus-monkemuller_endoscopic-resection-of-lsts-precise-localization-activity-7159200748767989760-w1yU
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280838/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308134/
[6] https://www.sciencedirect.com/science/article/pii/S2468448121002034
[7] https://twitter.com/EndoCollabcom/status/1753775490068832549
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414758/
[9] https://www.wjgnet.com/1948-5190/full/v14/i3/113.htm
[10] https://www.elsevier.es/en-revista-ge-portuguese-journal-gastroenterology-347-articulo-large-colorectal-lesions-evaluation-management-S2341454516000107
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132716/
[12] https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/reducing-post-polypectomy-bleeding-events-in-patients-who-require-antithrombotic-agents/mac-20479873
[13] https://www.giejournal.org/article/S0016-5107(20)34187-0/fulltext
[14] https://dmr.amegroups.org/article/view/8102/html
[15] https://www.researchgate.net/publication/260217120_Interventional_chromoendoscopy_Specific_aspects_for_the_colon
[16] https://journals.lww.com/ajg/fulltext/2017/10001/risk_factors_for_delayed_colonic_post_polypectomy.527.aspx
[17] https://www.sciencedirect.com/science/article/pii/S0016510720341870
[18] https://www.giejournal.org/article/S1096-2883(11)00003-9/fulltext
[19] https://karger.com/ddi/article/37/5/364/95746/Accuracy-and-Pitfalls-in-the-Assessment-of-Early
[20] https://www.dovepress.com/pathological-analysis-and-endoscopic-characteristics-of-colorectal-lat-peer-reviewed-fulltext-article-CMAR
[21] https://journals.lww.com/ajg/fulltext/2020/10001/s3373_endoscopic_mucosal_resection_of_a_lateral.3371.aspx
[22] https://www.linkedin.com/posts/endocollab_endoscopic-resection-of-lst-in-ascending-activity-7159541656394887168-cv5C
[23] https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-10-135
[24] https://www.frontiersin.org/articles/10.3389/fmed.2021.728704/full
[25] https://tcr.amegroups.org/article/view/48812/htmlhttps://www.gastroendopod.com
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In this episode of the Gastroenterology and Endoscopy podcast, we explore the importance of understanding and mastering different types of polypectomy snares in the endoscopic field. Not all lesions are the same, and using just one type of snare for all scenarios is often ineffective. We discuss the advantages of snares with expansial memory and hexagonal or oval snares with double buckles. The range of polypectomy snares available is vast, and each endoscopist will discover the snare that best suits their needs through practice and personal preference. Factors to consider when selecting a snare include the lesion's size and shape, the snare's ability to retain its shape and durability, and personal comfort and proficiency. Understanding and experimenting with various polypectomy snares enhances the ability to adapt to different clinical situations and leads to improved patient care.
Understanding Polypectomy Snares: A Guide for EndoscopistsPolypectomy snares are critical tools in the armamentarium of an endoscopist, and it’s essential to become adept with at least two types due to the variability in lesion sizes and shapes. A single snare type cannot accommodate all scenarios. Here’s a closer look at the diversity of snares and their functionalities:
Expansile Memory Snares: These snares are particularly notable. I favor using snares equipped with a robust expansile memory. This feature ensures the snare retains its shape and efficiency even after multiple uses.Hexagonal or Oval Snares with Double Buckles: Snares of this design tend to maintain an expanded state very effectively. This characteristic is valuable in ensuring consistent performance over repeated procedures.However, it’s crucial to remember — there’s a plethora of tools available. Each endoscopist will, through experience and preference, determine which snare aligns best with their practice. Let’s delve into some of the key factors to consider:
Lesion Size and Shape: The dimensions and morphology of the lesion dictate the type of snare required.Snare Memory and Durability: A snare that retains its shape after multiple uses is highly beneficial.Personal Comfort and Skill: Ultimately, the choice often boils down to what the endoscopist finds most efficient and comfortable to use.In summary, while the variety of polypectomy snares may seem daunting, understanding their unique features and testing different types can greatly enhance an endoscopist’s proficiency and adaptability in managing diverse lesions.
00:22 - Importance of Multiple Snare Types00:44 - Advantages of Snares with Memory00:55 - Features of Hexagonal and Oval Snares01:05 - Factors in Snare Selection01:37 - Conclusion and Significance of Snare Variety
TimestampsKeywords
Gastroenterology, Endoscopy, polypectomy snares, tools, techniques
endocollab.com
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In this episode, we delve into the intriguing world of Cameron lesions, a medical condition first identified in 1986. We explore what these lesions are, their causes, how they are diagnosed, and treatment options. This episode is a deep dive into the intricacies of medical diagnostics and highlights the importance of detailed observation in the field of gastroenterology.
Key Points Discussed:
Introduction to Cameron Lesions: Understanding what Cameron lesions are and their association with hiatal hernia.Historical Background: The discovery of Cameron lesions by Cameron and Higgins in the 1980s and their relevance in patients with a portion of the stomach above the diaphragm.Causes of Cameron Lesions: Exploring mechanical trauma, friction at the level of constriction, and other contributing factors like pressure differences during respiration and gastric acid.Prevalence and Diagnosis: Discussing the prevalence of Cameron lesions in patients with hiatal hernias and the role of esophagogastroduodenoscopy (EGD) in diagnosis.Challenges in Diagnosis: Understanding why Cameron lesions are often missed in initial EGDs and the importance of special attention during examinations.Treatment Options: The mainstay of treatment with proton-pump inhibitors (PPIs) and the necessity of iron supplementation.Conclusion: Emphasizing the significance of Cameron lesions in patients with large hiatal hernias and the need for a high index of suspicion among endoscopists.Recommended Resources:
https://endocollab.com/blogs/gi-endoscopy-tips-tricks/cameron-lesionshttps://www.thepracticingendoscopist.com/p/cameron-lesions
Timestamps:
- 00:00 Introduction to Cameron Lesions
- 00:12 Definition and Association with Hiatal Hernia
- 00:29 Discovery and Prevalence
- 01:09 Causes of Cameron Lesions
- 02:01 Diagnosis and Challenges
- 02:37 Treatment and Management
- 02:55 Association with Iron Deficiency Anemia and GERD
- 03:05 Significance and Importance of Cameron Lesions
- 03:26 Conclusion
Keywords:
Cameron lesions, hiatal hernia, gastric mucosal folds, mechanical trauma, local ischemia, mucosal stress, ulceration, EGD, proton pump inhibitors, iron deficiency anemia, GERD, size, overlooked, high index of suspicionhttps://www.gastroendopod.com
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In this episode of the Gastroenterology and Endoscopy Podcast, we explore the world of water-assisted colonoscopy (WAC). WAC is a technique that uses water instead of air or gas during the insertion phase of a colonoscopy, offering numerous benefits for both endoscopists and patients. By utilizing water's natural properties, WAC can reduce pain and discomfort, straighten out the colon, and enhance visibility of the mucosal surface. This technique not only improves patient comfort but also plays a crucial role in colorectal cancer prevention by improving adenoma detection rates. Join us as we delve into the advantages of WAC over traditional methods and its potential impact in the field of gastroenterology.
00:00:46 - "Studies have shown that water assisted colonoscopies can significantly reduce the pain associated with colonoscopy."00:03:35 - "To sum up, water is not just an alternative for colon distension in colonoscopy, it's an essential component that significantly elevates the effectiveness of the procedure."
QuotesResources
Water Assisted-Colonoscopy (WAC or Hydrocolonoscopy)Do You Use CO2 and Water Immersion in Diagnostic Colonoscopies on a Daily Basis?Keywords
water-assisted colonoscopy, WAC, hydrocolonoscopy, benefits, endoscopists, patients, concept, application, water, air, gas, insertion phase, colonoscopy, pain, challenging cases, colonoscope, bends, loops, straightening, angulations, gravitational effect, colonic elongation, loop formation, discomfort, sedation, water irrigation, visibility, mucosal surface, adenomas, precancerous growths, ADR, colorectal cancer prevention, air insufflation, water immersion, water exchange, duration, modified version, partial WAC, CO2, combination, tight angulations, colon elongation, cleaning, lumen, folds, polyp detection, modern colonoscopes, water jets, hybrid technique, suction, liberal use, overall quality, water, cleaning, mucosal surface, colonoscopy, debrishttps://www.gastroendopod.com
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In this episode of the Gastroenterology and Endoscopy podcast, we discuss a challenging case involving a pedunculated duodenal adenoma. These types of polyps present unique challenges for endoscopists, requiring meticulous planning for a successful procedure. The goal is to achieve a complete R0 resection, removing the entire lesion without leaving any microscopic remnants. We explore strategies to prevent migration of the polyp into the bowel, such as positioning the patient in a decubitus supine position or using an antimotility agent. The endoscopist and assistant must be on high alert to catch the polyp with the snare, and having a Roth's net on standby is recommended.
Chapters:
[00:02:16] Preventing complications.[00:04:10] Preparation is key.
Endoscopic Resection of Complex Duodenal PolypsDuodenal Polyp Resources on EndoCollab
Resources:
00:02:52 - "By allowing the neoplasm to float, we reduce the chances of transmitting electrosurgical current to the base of the lesion, minimizing the risk of perforation."00:03:06 - "And when it comes to closing the wound post-resection, clips are a must."
Quotes:Topics Discussed:
Introduction to Pedunculated Duodenal Adenoma: Brief description of the polyp’s location and importance of meticulous planning for resection.Achieving Complete Resection (R0): Importance of removing the entire lesion and considerations to make during resection.Preventing Polyp Migration: Strategies to prevent the polyp from moving into the distal bowel.Complication Prevention: Discussion on measures to prevent complications during and after endoscopic resection.Tools and Techniques: Exploration of various tools (snare, Roth’s net, distal transparent cap) and techniques (submucosal injection, underwater resection, use of endoloops and clips).Managing Immediate and Delayed Bleeding: Importance of using endoscopic clips and hemostatic hydrogels, especially in patients on anticoagulation.Proximity to the Papilla of Vater: Ensuring correct identification of the lesion’s location and planning the resection accordingly.Post-procedure Care: Importance of starting proton pump inhibitors post-procedure.Final Thoughts and Goodbye: Summing up the key takeaways from the episode and bidding farewell to the listeners.Keywords:
Gastroenterology, Endoscopy, pedunculated duodenal adenoma, endoscopic procedures, complications,closing the wound, post-resection, clips, duodenal endoscopic resections, bleeding complications, hemostatic hydrogels, Puristat, anticoagulation, proton pump inhibitors, healing process, polyp's proximity, papilla of vater, ampullary lesion, resection, side-viewing endoscope, complete R0 resection, pedunculated duodenal adenomas, preparation, plan, outcome, patient, insightful, helpful, practicehttps://www.gastroendopod.com
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In this episode, we discuss the importance of improving colonoscopy prep and achieving better Boston bowel preparation scores. Colon cancer is the second leading cause of cancer death in the US, but it is preventable through colonoscopies. However, the success of a colonoscopy relies heavily on proper bowel preparation. Inadequate prep can decrease polyp detection rates by 27%. Patients are advised to follow a special diet and take a bowel cleansing solution prior to the procedure to ensure a clear view of the colon. The cleanliness of the colon is graded using the Boston Bowel Preparation Scale, with a minimum score of 6 recommended for optimal polyp detection. Unfortunately, the endoscopy center discussed in the episode noticed alarmingly low Boston prep scores among their patients.
00:00:29 - "They allow doctors to have a clear view of the entire colon, catching precancerous polyps before they develop into cancer."00:04:13 - "The results of these changes have been nothing short of transformative."
Quotes:
Improving Colonoscopy Prep and Achieving Better Boston Bowel Preparation ScoresCan I have your experience with colonoscopy prep? I have noticed that most of the patients we receive don't have a good Boston score?
Chapters:
[00:01:45] Importance of Boston bowel preparation.
[00:04:25] Thorough colonoscopy PrEP is indispensable.
Read more:
Keywords:
colonoscopy prep, Boston bowel preparation scores, colon cancer, colonoscopies, bowel preparation, nurses, split-dose bowel preparation regimen, PrEP solutionhttps://www.gastroendopod.com
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In this episode we discuss using natural color changes called "biologic chromoendoscopy" to detect challenging flat colorectal lesions.
Key Topics Discussed:
- While sessile and pedunculated polyps are easy to spot endoscopically, flat and serrated lesions are challenging
- AI, virtual chromoendoscopy, and dyes aren't reliable for flat lesions obscured by mucus/debris
- Mucus changes light penetration, traps stool, and creates a hazy appearance
- Two mucin secretion changes: lost O-acetyl groups and increased sialylation
- "Chicken skin mucosa" refers to white spots from lipid-laden macrophages linked to adenomas, cancer, and juvenile polyps
- Melanosis coli is dark pigmentation from lipofuscin deposits due to chronic laxative use
- Recognizing subtle color changes is critical for finding precancerous flat lesions
- Human eye notices what AI systems miss when looking for discolored tissue
Key Quotes:
- "I call the lesions' natural color changes 'biologic chromoendoscopy.'"
- "Other examples are 'chicken skin mucosa' and melanosis coli."
- "Recognizing these subtle color changes is critical for finding precancerous flat lesions."
Links:
Biologic Chromoendoscopy – The Eye Beats Artificial Intelligence
References Made:
- Mucin secretion changes in serrated lesions
- Melanosis coli and anthraquinone laxative use
- Chicken skin mucosa first described in Japan
Keywords:
- colorectal cancer screening
- colonoscopy
- endoscopy
- polyp detection
- flat lesions
- sessile serrated lesions
- biologic chromoendoscopy
- natural chromoendoscopy
- chicken skin mucosa
- melanosis coli
- mucin secretion
- AI in endoscopy
- virtual chromoendoscopy
- chromoendoscopy techniques
- lipofuscin
- precancerous polyps
- colorectal polyps
- anthraquinone laxatives
- visual characterization of lesions
- hazy lesions
- discolored lesionshttps://www.gastroendopod.com
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Episode Overview:
https://endocollab.com/blogs/news/the-esd-emr-hybrid-technique-for-improved-endoscopic-resectionhttps://www.thepracticingendoscopist.com/p/the-esd-emr-hybrid-or-pre-cutting
In this episode, host Dr. Alan Smith discusses a new hybrid endoscopic technique that combines aspects of ESD and EMR to improve resection of difficult to remove gastrointestinal lesions.
Key Topics Covered:
- Limitations of traditional endoscopic resection techniques like ESD and EMR
- Overview of the ESD-EMR hybrid technique (also called pre-cutting EMR)
- Step-by-step explanation of how the hybrid technique works
- Types of challenging GI lesions the hybrid technique is useful for
- Benefits of the ESD-EMR approach over standard resection methods
- Limitations and alternatives to the hybrid technique
Episode Highlights:
- Laterally spreading colorectal lesions often cannot be fully resected with standard EMR snares due to slippery mucosa, leading to recurrence. The ESD-EMR hybrid technique creates a pre-cut groove around the lesion that enables complete en bloc snare resection.
- Serrated polyps in the colorectum frequently evade polypectomy snares because of their subtle mucosal surfaces. The hybrid technique overcomes this with circumferential pre-cutting to allow complete snare capture.
- For difficult to resect subepithelial tumors like lipomas, the combined ESD-EMR approach facilitates resection of larger lesions compared to standard EMR.
- The hybrid technique decreases recurrence rates and lowers perforation risks versus ESD in less experienced hands.
Notable Quotes:
"But ESD and EMR have limitations resecting certain flat, slippery lesions. Laterally spreading colorectal polyps often slip out of EMR snares, causing incomplete removal and recurrence."
"Making a customized groove around the lesion enables complete snare capture and resection of even challenging flat lesions."
"While limitations exist, this innovative ESD-EMR hybrid strategy expands the range of lesions treatable by endoscopic resection while minimizing recurrence and perforation risks."
Sources:Topics mentioned:
Endoscopy, ESD, EMR, endoscopic resection, endoscopic submucosal dissection, endoscopic mucosal resection, hybrid technique, pre-cutting, GI tumors, GI lesions, laterally spreading tumors, colorectal polyps, serrated polyps, adenomas, subepithelial tumors, lipomas, en bloc resection, snare resection, electrosurgery, submucosal injection, submucosal dissection, polypectomy, recurrence prevention, non-lifting lesions, fibrotic tumors, gastroenterologyhttps://www.gastroendopod.com
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In the latest episode of the Gastroenterology & Endoscopy Podcast we explore the innovative realm of Hemoclips, or Through-The-Scope-Clips, and their pivotal role in enhancing endoscopic procedures. Initially designed for hemostasis, these multifaceted tools have now widened their scope, proving to be indispensable in a variety of clinical scenarios.
Hemoclips
Hemoclips, now often referred to as "clips", have seen their application extend beyond their original purpose of hemostasis. They are now employed for a range of uses including closing perforations, post-resection defects, marking, and attaching devices like stents and feeding tubes. For instance, during procedures involving gastric, esophageal, or colon perforation, clips can effectively seal the defect, averting further complications. This adaptation of clips over time truly signifies a leap in medical innovation.Understanding the Anatomy and Deployment of Clips:
Grasping the anatomy and the mechanisms governing the deployment of clips is essential for their effective utilization. A typical clip comprises a stem with two arms with distal teeth. The design might vary; for instance, the arms' shape and number could differ, and so can the length of the stem. This length variation affects their use in narrow areas like small bowel strictures or esophageal stenosis. For example, a longer stem in a small bowel stricture could exacerbate the condition by rubbing against the mucosa on the opposite side. It’s imperative that we understand the anatomy to ensure the appropriate selection and use of these clips.Advancing and Applying Clips with Precision:
The advancement and application of these Through-The-Scope clips demand precision and care. When initially advancing the clip into the working channel of the scope, it's crucial to hold close to the tip to prevent bending the arm. Once the clip has navigated through the working channel and reaches the tip of the scope, it should be gently pushed out, opened, and pulled back towards the scope. For example, when addressing a bleeding lesion, the clip should be open and advanced towards the lesion by moving the endoscope. And at that pivotal moment, when the clip is near the target vessel or defect to be closed, it should be pushed out with the hand, then closed and released by the assistant. This meticulous handling and application of clips can significantly bolster patient outcomes.Mastering the Use of Clips:
The art of mastering the use of clips lies in a thorough understanding of their anatomy, their mechanics, and the knack of deploying them accurately, and applying them with precision. It's a journey of practice and learning that unveils the full potential of these versatile tools, thereby elevating patient care to new heights.Links / References:
EndoCollab.com: A Visual Guide to Hemoclips ApplicationsConclusion:
The Gastroenterology & Endoscopy field continually evolves with advancements like Hemoclips, pushing the boundaries and offering new horizons for better patient care. Mastering the use of these clips is not just about enhancing procedural efficiency but also about ensuring safer and improved patient outcomes.https://www.gastroendopod.com
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In this highly informative podcast, we explore the world of Inflammatory Fibroid Polyps or Vanek Tumors of the GI Tract. We discuss everything from their manifestation as submucosal lesions to their immunohistochemical characteristics. Get valuable insights into diagnosis techniques, anatomical locations, and treatment protocols. You'll also learn about the importance of immunohistochemistry in distinguishing between IFPs and other Gastrointestinal stromal tumors (GIST). Join us in our deep dive into this intricate world of gastroenterology.
Read more: https://www.thepracticingendoscopist.com/p/inflammatory-fibroid-polyps-ifp-orhttps://www.gastroendopod.com
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A phrygian cap gallbladder is a congenital anomaly of the gallbladder with an incidence of 4%. It can simulate a mass in the liver during hepatobiliary imaging and is sometimes mistaken for pathology. A Phrygian cap, however, has no pathological significance and normally causes no symptoms.
Links:
What is a Phrygian (Cap) Gallbladder?https://www.gastroendopod.com
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Ever wondered about the precision of medical instruments, how they are measured, or who pioneered this system? Join us on a captivating journey as we unearth the intriguing world of medical instrument measurements. We'll highlight the life and contributions of Swiss-French artisan, Joseph Frederick Benoit Chariere, the brain behind the French or Chariere gauge system. Used widely in endoscopy units worldwide, Chariere's precision instrument designs changed medical science forever. We'll discuss everything from scissors to syringes, anesthesia systems, and his innovative gauge system known for its uniform increments.
As we navigate the practical application of the French scale, you'll experience how it aids medical professionals in delivering precise treatments. Our discussion breaks down the complexities of this fascinating system and reveals its role in delivering vital medical equipment like catheters and stents. To bring it all to life, we'll delve into an exciting case study of balloon-assisted endoscopic retrograde colongeopancreatography, illuminating the importance of these measurements in real-world applications. Stay tuned for this engaging exploration into the precision and innovation that is at the heart of medical science.
Links:
- https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0043-119686.pdf
- https://www.thepracticingendoscopist.com/p/where-does-the-measurement-fr-frenchhttps://www.gastroendopod.com
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00:00 Intro
00:01:43 Spindle cell proliferation evaluation with Gave syndrome
00:03:07 Visit endocollab.com for more tips
Gastric antral vascular ectasia (GAVE) or watermelon stomach is an uncommon but important cause of gastrointestinal bleeding and anemia, first described in 1953 by Rider et al (1). GAVE is characterized by a “characteristic” endoscopic pattern, mainly represented by red spots either organized in stripes radially departing from pylorus (“watermelon stomach”, or arranged in a diffused-way or “honeycomb stomach”). In addition, there is a nodular variety, where there are multiple enlarged and nodular folds in the antrum (2, 3). Despite this GAVE is often misclassified or mis-diagnosed.https://www.gastroendopod.com
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- Importance of having a range of endoscopic tools
- Different types of tools (snares, basket nets, caps, over tubes, etc.)
- Choosing the right tool
- Teeth for firm grip on foreign bodies
- Dealing with capsule endoscopes in the GI tract
- 1% getting stuck in the small bowel
- Double balloon enteroscopy for removal
- Visualizing strictures and ulcers via fluoroscopy
- Preferred retrieval method: Rothnet or plain snares
- Extraction of gastric bands that migrate into the stomach
- Discomfort caused by migrated bands
- Use of gastric band cutters or biliary wire and lethal triptor device
- Requires patience and persistence
- Challenges of migrated stents in the esophagus
- Dilation of strictures can help
- Pushing the stent into the stomach with an overt tube and cap
- Grabbing the stent by its string and being gentle to avoid damage
- Increase in tight strictures in the esophagus possibly caused by ingestion of pills
- Standard practice to inject contrast after dilation for safety
- Reducing risks of perforation or damage
- Mastering foreign body extraction in GI endoscopy
- Importance of equipping oneself with a diverhttps://www.gastroendopod.com
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