The SAGES Manual Operating Through the Endoscope

Description

In 2016 the first edition of the SAGES Manual Operating through the Endoscope was published.   At the time, this represented a review of cutting-edge new technologies that were being introduced within the field of flexible endoscopy.  Largely based on applications and data up to 2013, this served as a unique resource for clinicians and researchers to learn about this expanding field.   Since then, there has been a significant expansion of new technologies and procedures within this discipline that have meaningfully changed this entire sub-specialty.  In addition, large numbers of high-quality data have emerged that support more heartily the safety and efficacy of these techniques.  Major international societies now routinely include hands-on training and scientific content of this field in meetings and educational efforts, and many trainees and practitioners are looking for resources to improve their knowledge and technical skills sets.  For these reasons, an update on this rapidly advancing field seems appropriate at this time, given the enormous amount of new content available.  Endoscopic surgical procedures allow for less invasive access for performing increasingly complex procedures.  This results in maximal benefit for patients with fewer complications, faster recovery, and less pain.  Endoscopy allows access to the gastrointestinal tract without transgressing the abdominal or chest walls, by means of a truly less invasive route.  These technologies and skills are being sought out by practitioners and asked for by patients. The proposed textbook is designed to present a comprehensive and state-of the-art approach to the diverse applications of surgical techniques and procedures through the endoscopic platform.  Written by experts and emerging  specialists in that field, each of these sections will address patient selection, pre-operative considerations, technical conduct of the most common operations, and avoiding complications.  A review of the existing literature addressing the particular topic will follow in each section.  Extensive endoscopic images and illustrations will make this an interactive text.  In addition to updates on most topics in the previous manual, this edition will include exciting new fields of advanced imaging, artificial intelligence and augmented imaging, applications of robotics to endoscopy, and more robust exposure of endoscopic applications for treatment of obesity, a worldwide epidemic. The subject of surgical endoscopy has changed meaningfully since publication of the first edition; now a substantial focus of major journals, scientific meetings, and online platforms.  A timely update can capture this broad subject in an accessible manual focused on technologies and data supporting these interventions. Preface Acknowledgments Contents Chapter 1: The Interface Between Therapeutic Gastrointestinal Endoscopy and Endoscopic Gastrointestinal Surgery References Chapter 2: Endoscopic Tools: Instruments Introduction Endoscope Standard Instruments Forceps Snare Injection Catheter Endoscopic Cutting Tools Retrieval Devices Endoscopic Wires Balloon Catheters Clips Band Ligation Energy Devices Electrocautery and Thermocoagulation Probes Radiofrequency Ablation Catheters Argon Plasma Coagulation Catheters ERCP Instruments Sphincterotome Endoscopic Balloons Endoscopic Baskets Biliary Stents Cholangioscopy References Chapter 3: Operating Platforms for Surgical Endoscopy Introduction History of Surgical Endoscopy Traditional Endoscope-Assisted Visualization Platforms Direct Drive Endoscopic System (DDES) Incisionless Operating Platform (IOP) Endomina System DiLumen C2 and the Endolumenal Interventional Platform (EIP) LumenR Tissue Retractor System Integrated Visual Function Platforms EndoSamurai ANUBIScope Flex Robotic System Robotic Platforms ViaCath System Master and Slave Translumenal Endoscopic Robot (MASTER) System Endoluminal Surgical (ELS) System Additional Gastrointestinal Platforms Bronchoscopy Platforms Conclusion References Chapter 4: Endolumenal Electrosurgical Energy Overview of Endolumenal Electrosurgery Endosurgical Units and Common Endolumenal Devices Risk Associated with Endolumenal Electrosurgical Devices Future Directions References Chapter 5: Endoscopic Training—Surgeon and GI Paradigms Scope of Practice for GI Endoscopists vs General Surgeons ACGME/ABS Requirements for Surgical Trainees Advanced Surgical Endoscopy Training ASGE Requirements for Gastroenterology Fellows Training Adjuncts for Fellows and Residents The Effect of COVID-19 on Endoscopy Training Community Practice Patterns and the Need for General Surgeon Endoscopists References Chapter 6: Advanced Training and Certifications in Endoscopy Introduction Training in Endoscopy Defining Competence Ablative Therapies Endoscopic Bariatric and Metabolic Therapies (EBMTs) “Third space” Endoscopy ESD POEM Future Directions Conclusion References Chapter 7: Upper Gastrointestinal Tract Bleeding Introduction Clinical Presentation Initial Assessment Nasogastric Tubes Resuscitation and Transfusion Risk Stratification Timing of Endoscopic Intervention Endoscopic Management of UGIB Management of Nonvariceal UGIB (NVUGIB): The Arsenal Injection Therapy Mechanical Therapy Thermal Therapy Topical Therapy The Right Intervention for the Right Pathology Peptic Ulcer Disease (PUD) Mallory–Weiss Tears (MWT) Dieulafoy’s Lesion (DL) Post-Surgical Acute Bleeding (PSAB) Tumor Bleeding Variceal UGIB (VUGIB) Esophageal Varices (E.V.) Gastric Varices (G.V.) Conclusion References Chapter 8: Stricture Management: Interventional Options Esophageal Anastomotic Strictures Definition Pathophysiology Incidence and Risk Factors Symptoms Treatment Dilators Rigid Dilators Balloon Dilators Novel Transparent Dilators Complications and Limitations of Dilators Other Endoscopic Procedures Stents Metal Stents Non-Metal Stents Biodegradable Stents Corticosteroid (Triamcinolone acetonide) Injection Mitomycin C Electrosurgical Needle Knife Medical Management Gastric Anastomotic Strictures Definition Pathophysiology Incidence and Risk Factors Treatment Balloon Dilators Other Endoscopic Procedures Endolumenal Stents Savary-Gilliard Dilators Colorectal Anastomotic Strictures Definition Pathophysiology Incidence and Risk Factors Treatment Balloon Dilators Other Endoscopic Procedures Rigid Dilators Stents Electrosurgical Coagulation Endoscopic Transanal Resection of Strictures (ETAR) References Chapter 9: Upper Gastrointestinal Tract Leaks Introduction Early Diagnosis of GI Leaks Management of Gastrointestinal Leaks in Esophagogastric Surgery Endoscopic Stent and Suturing Management of Anastomotic Leakage after Esophagogastric Surgery Endoscopic Suturing of Esophageal Leaks Endoscopic Vacuum-Assisted Closure in Esophageal Anastomotic Leaks Endoscopic Internal Drainage in Esophageal Anastomotic Leaks Endoscopic Stent and Suturing Management of Gastrointestinal Leak After Gastric Bypass and Sleeve Gastrectomy Early Gastrointestinal Leak After Gastric Bypass Delayed Leak with Abscess Early Gastrointestinal Leak after Sleeve Gastrectomy (LSG) Endoscopic Clips and Suturing in Gastrotomy Closure Endoscopic Internal Drainage and Endoscopic Vacuum Therapy After Sleeve Leak Summary References Chapter 10: Endoscopic Treatment of Gastrointestinal Leaks Introduction Classification Diagnosis Endoscopic Treatment of Fistulae Balloon Dilation Stricturotomy Endoclips Self-Expanding Luminal Stent Endoscopic Internal Drainage Endoscopic Suture Endoscopic Vacuum Therapy (EVT) Tissue Sealant Conclusion References Chapter 11: Lower Gastrointestinal Tract Bleeding Introduction Etiology Initial Assessment and Management Diagnostic and Treatment Options Esophagogastroduodenoscopy Colonoscopy Computed Tomography Angiography Therapeutic Mesenteric Angiography Radionuclide Imaging Surgery Conclusion References Chapter 12: Endoscopic Stenting for Malignant Colorectal Obstruction Background Indication for Stenting (Table 12.1) Bridge to Surgery Palliative Contraindications to Stenting Types of Stents Covered Versus Uncovered Stents Placement of the Stent Post-Stenting Follow-up Complications after Stent Placement Conclusion References Chapter 13: Interventional Procedures for Inflammatory Bowel Disease Introduction Endoscopic Management of Strictures Endoscopic Balloon Dilation Stricturotomy Stent Placement Intralesional Injection Dysplasia Diagnosis and Management Diagnosing IBD-Associated Dysplasia Endoscopic Management of IBD-Associated Dysplasia Other Therapeutic Endoscopic Procedures Management of IBD Post-Operative Complications Fistulas Conclusion References Chapter 14: Enteral Access: Percutaneous Endoscopic Gastrostomy, Gastrostomy-Jejunostomy, and Jejunostomy Introduction Patient Selection Gastric Feeding and Decompression Jejunal Feeding Special Considerations Absolute Contraindications Preoperative Considerations Antibiotic Prophylaxis Sedation Anticoagulation and Antiplatelet Consent Techniques Percutaneous Endoscopic Gastrostomy Push and Introducer Techniques Safe Tract Technique Percutaneous Endoscopic Gastrjejunostomy Percutaneous Endoscopic Jejunostomy Laparoscopic Jejunostomy Complications Injury to Internal Organs Fistula Volvulus Metastasis at PEG Site Aspiration and Pneumonia Necrotizing Fasciitis Buried Bumper Syndrome Peristomal Infection Gastrointestinal Bleeding and Ulceration Leakage Dislodgement and Inadvertent Removal Gastrointestinal Obstruction Clogged PEG Tube Pneumoperitoneum Removal and Replacement of PEG Conclusion References Chapter 15: Barrett’s Esophagus Surveillance: WATS, Real-Time Endoscopic Microscopy Introduction Wide-Area Transepithelial Sampling Technology Overview Clinical Evidence Endoscopic Microscopy Confocal Laser Endomicroscopy Optical Coherence Tomography Conclusions References Chapter 16: Barrett’s Esophagus Treatment: Radiofrequency and Other Ablation Modalities Introduction Radiofrequency Ablation Introduction Indications Technique Complications Outcomes Special Considerations Conclusion Chemical Photodynamic Therapy Cryotherapy Conclusion References Chapter 17: Endoluminal Gastroesophageal Reflux Disease Therapies Introduction Diagnosis and Management Specific Endoluminal Therapies Esophyx and Transoral Incisionless Fundoplication Stretta® Radiofrequency Treatment of the Gastroesophageal Junction Introduction Mechanism of Action Patient Selection Stretta® Technique Complications and Safety Clinical Results The Future of Endolumenal GERD Therapies References Chapter 18: Endomucosal Resection of the Upper GI Tract Esophagus Stomach Duodenum Patient Selection and Pre-operative Considerations Technique Injection-Assisted EMR Cap-Assisted EMR Ligation-Assisted EMR Underwater EMR Avoiding Complications Bleeding Stricture Perforation Complete Barrett’s Eradication Versus Targeted Resection Conclusions References Chapter 19: Endoscopic Mucosal Resection: Colon and Rectum Introduction Why Should These Lesions Be Managed Primarily by Endoscopic Mucosal Resection and Not Surgical Colectomy? Preparation for Endoscopic Mucosal Resection What Are the Main Aims of Endoscopic Mucosal Resection of Benign Colorectal Neoplasia? What to Do When These Lesions Are Discovered During Routine Colonoscopy? Endoscopic Prerequisites for Performing Endoscopic Mucosal Resection Carbon Dioxide Insufflation Microprocessor-Controlled Electrosurgical Generators Submucosal Injectate Snares Lesion Assessment Overview and Focal Lesion Assessment Risk Stratification of Covert Submucosal Invasive Cancer Endoscopic Mucosal Resection Technique Lesion Access and Positioning Submucosal Injection Technique Resection Technique Complications and Optimizing Outcomes Intraprocedural Bleeding Delayed Bleeding Deep Mural Injury and Perforation Adenoma Recurrence Thermal Ablation of the Post-EMR Margin Technique Special Locations and Salvaging Techniques Anorectal Junction Lesions Ileocecal Valve Lesions Circumferential Lesions Non-lifting Lesions Surveillance and Post-EMR Scar Assessment Post-procedural Care Diet Pain Cold Endoscopic Mucosal Resection Cold Endoscopic Mucosal Resection Technique Summary References Chapter 20: Endoscopic Submucosal Dissection: Upper Gastrointestinal Tract Introduction Comparison to Traditional Endoscopic Mucosal Resection ESD Indications Gastric ESD Indications Esophageal ESD Indications Preoperative Assessment ESD Equipment Distal Attachments Lifting Solutions ESD Knives Coagulation Devices Esophageal ESD Technique Marking Esophageal ESD Techniques Clip Line Traction Tunnel ESD C-Shaped Incision: IT Tunneling Technique Gastric ESD Technique Marking Circumferential Incision Submucosal Dissection Retraction Technology to Assist Esophageal and Gastric ESD Clip Line Traction Water Pocket Tunnel ESD S-O Clip Traction Wire Adverse Events Bleeding Perforations Stricture Conclusion References Chapter 21: Endoscopic Submucosal Dissection in Colon and Rectum Introduction Background Indications Periprocedural Management Injectate Types and Injection Techniques Materials and Devices Endoscopic Mucosal Resection Endoscopic Submucosal Dissection Complications of Advanced Polypectomy Updates in ESD and Future Directions Learning Curve Conclusion References Chapter 22: Peroral Endoscopic Myotomy (POEM) Indications Achalasia Emerging Indications History/Background Patient Selection Symptom Assessment Questionnaires Physiologic Tests High-Resolution Manometry Timed Barium Esophagram (TBE) Esophagogastroduodenoscopy (EGD) EndoFLIP Contraindications Patient Factors Technical/Training Pre-operative Care Patient Instructions Anesthetic Considerations Room Set-Up and Equipment Operative Technique [Fig. 22.4] Diagnostic Endoscopy Mucosal Lift and Mucosotomy Creation of the Submucosal Tunnel Anterior Myotomy of the Circular Muscle Layer Closure of Mucosotomy Troubleshooting Retained Debris Avoiding Complications Implications of COVID-19 Pandemic Aspiration Capnothorax Bleeding Full-Thickness Perforation Postoperative Care Follow-Up Review of Existing Literature Efficacy Rates of GERD Conclusion References Chapter 23: Intramural Surgery Per Oral Endoscopic Myotomy for Zenker’s Diverticulum (Z-POEM) Intramural Surgery Per Oral Endoscopic Myotomy for Zenker’s Diverticulum (Z-POEM) General Technical Principles Flexible Endoscopic Septum Division Submucosal Tunneling Technique: Z-POEM [Q] Endoscopic Mucosal Incision and Muscle Interruption (MIMI) Postoperative Care Outcomes Future Developments References Chapter 24: Intramural Surgery: Per Oral Pyloromyotomy Development of the Per Oral Pyloromyotomy The Nature of the Problem: Gastroparesis The Evidence Pre-operative Work Up The Set Up Step by Step Per Oral Pyloromyotomy Post-operative Management Future References Chapter 25: Per-Oral Endoscopic Tunneling for Restoration of the Esophagus (POETRE) Complete Esophageal Obstruction Endoscopic Treatment Options Per-Oral Endoscopic Tunneling for Restoration of the Esophagus (POETRE) History Pre-operative Considerations Anesthetic Considerations Patient Positioning and Pre-operative Medications Technique Step 1: Endoscopic Assessment Step 2: Fluoroscopic Measurements Step 3: Saline Lift and Mucosotomy Step 4: Submucosal Tunnel Formation Step 5: Navigation Across the Obstructed Segment Step 6: Passing of the Guidewire and Stent Placement Post-procedure Care Results Complications Bleeding Perforation Conclusion References Chapter 26: Operating Through the Endoscope: Endoscopic Full-Thickness Resection Background Current Techniques Used for EFTR Exposed EFTR Tunneled Exposed EFTR Non-tunneled Exposed EFTR Non-exposed EFTR Indications for EFTR Contraindications of EFTR Preoperative Considerations Post-operative Care and Follow-Up Clinical Outcomes of ETFR Efficacy of EFTR in Upper Gastrointestinal Tract Lesions Esophageal Tumors Gastric Tumors Duodenal Tumors Efficacy of EFTR in Lower Gastrointestinal Tract Lesions Colonic Tumors Limitations and Challenges Conclusion and Future Perspectives References Chapter 27: Submucosal Tunneling Endoscopic Resection of GI Submucosal Tumors Background Description Efficacy Conclusion References Chapter 28: Thoracic Applications Per Oral Plication of the Esophagus (POPE) Introduction Megaesophagus Achalasia End-Stage Treatment Clinical Approach Neoesophagus Delayed Gastric Emptying Clinical Approach Operative Description Device Procedure Technical Considerations Durability Conclusion References Chapter 29: Thoracic Applications: Endoscopic Approaches to Benign Esophagorespiratory Fistula Closure Introduction Evaluation of Fistula Therapeutic Approaches Stenting Mechanical Closure Techniques Occlusion of Tract Mucosal Disruption Endoscopic Mucosal Resection Clinical Success Conclusion References Chapter 30: Endoscopic Ultrasound (EUS) Guided Biliary Drainage History and Background Training Issues Indications Definitions EUS-BD with Emphasis on EUS-GBD Procedure Outcomes Description of Techniques Common Bile Duct (CBD) Drainage EUS Gallbladder Drainage (EUS-GBD) Hepaticogastrostomy Rendez-vous Technique Conclusions References Chapter 31: EUS-Directed Transgastric ERCP (EDGE Procedure) for Management of Choledocholithiasis in Post-Gastric Bypass Anatomy Introduction Technical Innovation Techniques and Pitfalls Outcomes Conclusions References Chapter 32: Advanced EUS: Future Applications Introduction Diagnostic EUS Therapeutic EUS References Chapter 33: Cholangioscopy Cholangioscopy Transhepatic Cholangioscopy Peroral Cholangioscopy Electrohydraulic Lithotripsy Conclusion References Chapter 34: Role of Endoscopic Bariatric Therapies in a Comprehensive Multidisciplinary Metabolic and Bariatric Program Introduction Pre-operative Endoscopy Intra-Operative Endoscopy Endoscopy to Manage Post-operative Complications Endoscopy and Dilation for Stricture After RYGB and SG Endoscopy for Upper GI Bleeding After RYGB Endoscopy for Treatment of Leaks Primary Endoscopic Therapy for Obesity Space Occupying Devices Endoscopic Suturing/Stapling Devices Aspiration Therapy Endoscopic Small Intestine Bypass Technology Conclusions References Chapter 35: Endoscopic Anatomy of the Bariatric Patient Introduction Pre-operative Endoscopic Evaluation Postoperative Endoscopic Evaluation Sleeve Gastrectomy Normal Findings Abnormal Findings Chronic Sleeve Fistula Roux-en Y Gastric Bypass Normal Findings Abnormal Findings A Laparoscopic Adjustable Gastric Band (LAGB) Normal Findings Abnormal Findings Band Erosion Biliopancreatic Diversion with Duodenal Switch (Single Vs. Two Anastomosis) Normal Findings Abnormal Findings Vertical Banded Gastroplasty Normal Findings Abnormal Findings Conclusions References Chapter 36: Intragastric Balloon Therapy Placement and Removal Conclusion References Chapter 37: Endoscopic Liners (Duodenojejunal Bypass Liner, Gastroduodenojejunal Bypass Sleeve) Introduction Implantation/Retrieval Pre-Implantation/Post-Implantation Considerations Indications/Contraindications EndoBarrier Is Contraindicated in the Following Patients Clinical Outcomes/Efficacy Mechanisms of Action Complications Summary References Chapter 38: Endoscopic Sleeve Gastroplasty Introduction Indication Contraindications How ESG Induces Weight Loss Setup/Tools Requirement (Table 38.2) Device Overview Technique Alternate Suturing Patterns Reinforcement ESG in Pediatric Age Group Perioperative Protocol for Patients Undergoing ESG Results Impact of ESG on Weight Loss Complications and Management Conversion to Laparoscopic Sleeve Gastrectomy (LSG) and Redo ESG ESG as a Revisional Procedure How Does ESG Compare to Laparoscopic Sleeve Gastrectomy? Barriers and Concerns Pearls in Performing ESG ESG Technical Principles Improve Visualization and Orientation Conclusion References Chapter 39: New Technologies to Treat Obesity and Related Comorbidities Introduction Duodenal Mucosal Resurfacing (DMR) Magnetic Anastomosis System (GI Windows Inc.) Intragastric Satiety-Inducing Device (ISD) Sleeveballoon Gastric Mucosal Devitalization (GMD) Conclusion References Chapter 40: Endoscopic Bariatric Revisional Procedures Introduction Endoscopic Procedures and Devices Transoral Outlet Reduction (TORe) Restorative Obesity Surgery Endoscopic (ROSE) Argon Plasma Coagulation of the Gastrojejunal Anastomosis Endoscopic Sclerotherapy Future Directions Summary References Chapter 41: ERCP and the Bariatric Patient Introduction RYGB (Fig. 41.1) OAGB (Fig. 41.2) BPD-DS (Fig. 41.3) SADI-S or OADS (Fig. 41.4) Management Enteroscopy-Assisted ERCP Transgastric ERCP Surgical Transgastric ERCP Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Surgical Transenteric ERCP Evidence-Based Algorithm for Choledocholithiasis Post-RYGB Conclusion References Chapter 42: Hybrid Laparoscopic and Endoscopic Techniques: Upper Gastrointestinal Tract Introduction Gastric Lesions Gastrointestinal Stromal Tumor (GIST) Gastric Cancer Gastric Hybrid Procedures Patient, Surgeon, and Endoscopist Positioning Classic LECS (Laparoscopic and Endoscopic Cooperative Surgery) Inverted LECS NEWS (Non-exposed Endoscopic Wall-Inversion Surgery) CLEAN-NET (Combined Laparoscopic Endoscopic Approach to Neoplasia with a Non-exposure Technique) Closed LECS Discussion Gastric Lesions Duodenal Lesions Future Conclusion References Chapter 43: Hybrid Laparoscopic and Endoscopic Techniques: Colon and Rectum Laparoscopic-Assisted Endoscopic Polypectomy (LAEP) Endoscopic-Assisted Wedge Resection Laparoscopic-Assisted Transluminal Resection Endoscopic-Assisted Laparoscopic Segmental Resection Preoperative Preparation Operative Setup Operative Procedure Colonoscopy (Fig. 43.2) Port Placement Colon Mobilization and Manipulation Polypectomy (Figs. 43.3, and 43.4) Full-Thickness CELS Colonoscopic-Assisted Laparoscopic Partial Cecectomy (Fig. 43.6) Intraoperative Frozen Pathology Complications Postoperative Care Follow-Up Contraindications Learning Curve Conclusion References Chapter 44: Natural Orifice Translumenal Endoscopic Surgery (NOTES™) Introduction History Current Status of Procedures Transesophageal Transgastric Transvaginal Transanal Ongoing Challenges Future Directions References Chapter 45: Artificial Intelligence in Endoscopy Introduction Definitions and Terminology Machine Learning (ML) Deep Learning (DL) Current Applications of Artificial Intelligence in Endoscopy Evaluation of Barrett’s Esophagus Esophageal Squamous Cell Carcinoma Detection of Helicobacter pylori (H. pylori) infection Colonic Polyp Detection Detection of Inflammatory Conditions AI—Limitations and Challenges Conclusion References Chapter 46: Advanced Imaging Through The Endoscope High-Definition Endoscopy Chromoendoscopy Virtual Chromoendoscopy Confocal Laser Endomicroscopy Conclusion References Chapter 47: Robotics in Endoscopy/Tele-Endoscopy History Current Robotic Endoscopy Systems Invendoscope E200™ System (Invendo Medical, GmBH Germany) Flex® Robotic System (Medrobotics Corp., Raynham MA) Monarch® Robotic Platform Ion™ Robotic Platform Products in Development EndoMaster EASE (Endoluminal Access Surgical Efficacy) System ISIS-Scope/STRAS System Summary and Future Directions References Chapter 48: Future Horizons in Flexible Endoscopy Introduction Flexible Robotic Endoscopy AI and Deep Learning Robotic Endoscopic Capsules Therapeutic Endoscopic Ultrasound Augmented Imaging and Navigation Conclusion: New Role for NOTES? References Index