Innovations in Gastrointestinal Endoscopy

Preface
Contents
About the Editors
1: Gastric Peroral Endoscopic Myotomy: G-POEM
	1.1	 Introduction and Background
	1.2	 Gastroparesis Assessment and Grading: How to Assess?
	1.3	 Endoscopic Procedure: How to Do?
	1.4	 Results of G-POEM
	1.5	 Are Long-Term Results Yet Available?
	1.6	 Is There Any Predictive Factor for Efficacy?
	1.7	 What Are the Expected Complications?
	1.8	 Future, Questions and Ongoing Development
	References
2: EUS-Guided Gastroenterostomy
	2.1	 Emerging Endoscopic Ultrasonography-Guided Gastroenterostomy
	2.2	 Technical Indication of EUS-GE [9]
	2.3	 History of Lumen-Apposing Metal Stents
	2.4	 EUS-GE Techniques [1–3, 9]
		2.4.1	 Direct EUS-GE Technique
		2.4.2	 Assisted EUS-GE Technique
		2.4.3	 EPASS (Figs. 2.3 and 2.4)
	2.5	 Outcomes of EUS-GE for MGOO
	2.6	 Future Clinical Application of EUS-GE
	References
3: The Pocket-Creation Method of Endoscopic Submucosal Dissection
	3.1	 Introduction
	3.2	 Advantages of the Pocket-Creation Method
	3.3	 Devices Suitable for the Pocket-Creation Method
	3.4	 The Procedure for the Pocket-Creation Method
	3.5	 Case Presentation: The Pocket-Creation Method of ESD
	3.6	 Conclusion
	References
4: Endoscopic Ultrasound (EUS)-Guided Biliary Drainage
	4.1	 Introduction
	4.2	 Material
		4.2.1	 Interventional Echoendoscopes
		4.2.2	 Needles and Accessories for Drainage
	4.3	 Technique for Biliary Duct Drainage Under EUS Guidance
	4.4	 Technique of Left HepaticoGastrostomy Under EUS Guidance (HGE) (Fig. 4.3)
		4.4.1	 EUS-Choledoco-Duodenostomy (Fig. 4.4)
	4.5	 EUS-Guided Rendez-Vous Technique
		4.5.1	 Endoscopic Ultrasonography-Guided Transhepatic Anterograde Self-Expandable Metal Stent (SEMS) Placement (Fig. 4.5)
	4.6	 Place of the Bilio-Digestive Anastomosis Guided by EUS in Comparison with ERCP
		4.6.1	 What Stent Should Be Used?
	4.7	 Conclusion
	References
5: EUS-Guided Gallbladder Drainage
	5.1	 Introduction
	5.2	 Development of EUS-GBD
	5.3	 Indications for EUS-GBD
	5.4	 Technique of EUS-GBD
	5.5	 Outcomes of EUS-GBD
	5.6	 Follow-up After EUS-GBD
	5.7	 Peroral Cholecystoscopy and Advanced Gallbladder Interventions
	5.8	 Conclusion
	References
6: Endoscopic Management of GERD
	6.1	 Definition of Refractory GERD
	6.2	 Approach to Refractory GERD
	6.3	 Endoscopic Anti-Reflux Therapies
	6.4	 Radiofrequency Ablation
	6.5	 Transoral Incisionless Fundoplication
	6.6	 Medigus Ultrasonic Surgical Endostapler
	6.7	 Endoscopic Full Thickness Plication (EFTP)
	6.8	 Anti-Reflux Mucosectomy
	6.9	 EARMs: Strengths and Shortcomings
	References
7: Anti-reflux Mucosectomy and Anti-reflux Mucosal Ablation
	7.1	 Introduction
	7.2	 Anti-reflux Mucosectomy (ARMS) and Anti-reflux Ablation (ARMA)
		7.2.1	 Indications
		7.2.2	 Exclusion Criteria
		7.2.3	 Pre-assessment
		7.2.4	 Anti-reflux Mucosectomy (ARMS)
			7.2.4.1	 Technique
			7.2.4.2	 Management and Follow-up Post-ARMS
			7.2.4.3	 Outcome
		7.2.5	 Anti-reflux Mucosal Ablation (ARMA)
			7.2.5.1	 Technique
			7.2.5.2	 Postoperative Management
			7.2.5.3	 Outcome
	7.3	 Conclusions
	References
8: Biliary Radio Frequency Ablation (RFA)
	8.1	 Introduction
	8.2	 Principles of RFA System
	8.3	 RFA Devices
	8.4	 Malignant Biliary Strictures
	8.5	 Biliary Involvement of Ampulla Adenoma
	8.6	 Treatment of Occluded SEMS
	8.7	 Safety of Biliary RFA
	8.8	 Conclusions
	References
9: Endoscopic Sleeve Gastroplasty
	9.1	 Technical, Procedural, and Patient Considerations
	9.2	 Operator Learning Curve
	9.3	 Physiologic Mechanisms
	9.4	 Patient Outcomes
		9.4.1	 Clinical Success in ESG: Percent Total Body Weight Loss
		9.4.2	 Comparison to Alternative Bariatric Procedures
		9.4.3	 Outcomes in Obesity-Associated Conditions
		9.4.4	 Predictors of Clinical Success in ESG
		9.4.5	 Adverse Events
	9.5	 Re-Do, Reversal, and Surgical Revision
	9.6	 Areas for Future Research and Discussion
	References
10: Full-Thickness Resection
	10.1	 Introduction
	10.2	 Techniques and Devices for Endoscopic Full-Thickness Resection
		10.2.1	 Exposed Versus Non-exposed Full-Thickness Resection
		10.2.2	 Full-Thickness Resection Device—FTRD
		10.2.3	 Clip-Assisted Full-Thickness Resection
		10.2.4	 Pure Endoscopic, Full-Thickness Resection Techniques in the Upper Gastrointestinal Tract
		10.2.5	 Combined Endoscopic and Laparoscopic Full-Thickness Resection
	10.3	 Gastric Full-Thickness Resection
	10.4	 Full-Thickness Resection in the Duodenum
	10.5	 Colorectal Full-Thickness Resection
		10.5.1	 Indications and Techniques
		10.5.2	 Efficacy of Full-Thickness Resection in the Colorectum
		10.5.3	 Complications of Colorectal Full-Thickness Resection
		10.5.4	 Special Situations
		10.5.5	 Follow-Up After FTRD Resection in the Colorectum
	10.6	 Summary
	References
11: Colonic Endoscopic Mucosal Resection
	11.1	 Introduction
	11.2	 Lesion Selection and Preparation
		11.2.1	 Morphological Classification of Colonic LSLs
		11.2.2	 Assessment of Surface Pit and Vascular Pattern
	11.3	 Endoscopic Mucosal Resection Technique
		11.3.1	 Patient Preparation
		11.3.2	 Submucosal Injectate and Snares
		11.3.3	 Resection Technique
			11.3.3.1	 Submucosal Injection
			11.3.3.2	 Snare Resection
	11.4	 Variant Techniques
		11.4.1	 Piecemeal Cold Snare Polypectomy
		11.4.2	 Underwater EMR
	11.5	 Special Considerations
		11.5.1	 LSLs in the Anorectum
		11.5.2	 Peri-Appendiceal and Ileocaecal Valve LSLs
		11.5.3	 Large Pedunculated Polyps
		11.5.4	 Lesions Previously Attempted for Resection
	11.6	 Aftercare
	11.7	 Managing Complications
		11.7.1	 Intra-procedural Bleeding
		11.7.2	 Delayed Bleeding
		11.7.3	 Perforation
		11.7.4	 Post-polypectomy Electrocoagulation Syndrome and Delayed Perforation
	11.8	 Conclusion
	References
12: Endoscopic Mucosal Resection for Early Esophageal and Gastric Cancers
	12.1	 Introduction
	12.2	 Endoscopic Mucosal Resection
		12.2.1	 EMR Technique
		12.2.2	 Cap-Assisted Method
		12.2.3	 Multiple-Band-Assisted EMR
	12.3	 Use of EMR for Esophageal Cancers
		12.3.1	 Use in Esophageal Squamous Cell Cancer (ESCC)
		12.3.2	 Use in Esophageal Adenocarcinoma (EAC)
		12.3.3	 EMR for Early Gastric Adenocarcinoma (EGC)
	12.4	 Adverse Events
	12.5	 Future of Endoscopic Mucosal Resection
	References
13: Endoscopic Duodenal Mucosal Resurfacing: A Potential Therapeutic Treatment for Metabolic Disease
	13.1	 Introduction
	13.2	 Endoscopic Duodenal Mucosal Resurfacing
		13.2.1	 Proof-of-Concept Study in Animal Models
		13.2.2	 Duodenal Mucosal Resurfacing Procedure
		13.2.3	 Safety and Effectiveness of Duodenal Mucosal Resurfacing Using the Revita TM System in Treatment of Type 2 Diabetes and Wider Effects on Fatty Liver Disease
	13.3	 Conclusion and Perspectives
	References
14: Electronic (Virtual) Chromoendoscopy
	14.1	 Overview of Currently Available Techniques for Virtual Chromoendoscopy
		14.1.1	 Introduction
		14.1.2	 Narrow-Band Imaging (NBI)
		14.1.3	 Flexible Spectral Imaging Colour Enhancement (FICE)
		14.1.4	 Blue Light Imaging (BLI), Linked Colour Imaging (LCI)
		14.1.5	 I-Scan Digital Contrast (Pentax)
		14.1.6	 I-Scan OE Technology (Pentax)
		14.1.7	 Auto-Fluorescence Imaging (Olympus)
		14.1.8	 Storz Professional Image Enhancement Software (SPIES)
	14.2	 Electronic Chromoendoscopy in the Upper GI Tract
		14.2.1	 Narrow-Band Imaging NBI for Barrett’s Neoplasia
		14.2.2	 NBI for Squamous Neoplasia
		14.2.3	 Flexible Spectral Imaging Colour Enhancement FICE
		14.2.4	 Blue Light Imaging BLI
		14.2.5	 i-Scan
	14.3	 Electronic Chromoendoscopy in the Lower GI Tract
		14.3.1	 EC in Detection of Colorectal Polyps
		14.3.2	 EC for Differentiation between Neoplastic and Non-neoplastic Diminutive Colorectal Polyps
		14.3.3	 Examination of Post-polypectomy Scar Site
	References
15: Stenting for Pancreatic Walled-Off Necrosis (WON)
	15.1	 Introduction
	15.2	 Medical Management
	15.3	 Drainage
		15.3.1 Indication for Drainage of Pancreatic WON
		15.3.2 Contraindication for Endoscopic Drainage
		15.3.3 Timing of Intervention
		15.3.4 Pre-drainage Patient Evaluation
		15.3.5 Drainage Techniques
		15.3.6 Endoscopic Techniques
			15.3.6.1	 Trans-Papillary Drainage
		15.3.7 Endoscopic Transmural Drainage
		15.3.8 Equipment for EUS-Guided Transmural Drainage (Table 15.3)
		15.3.9 EUS-Guided Transmural Technique
		15.3.10 The Technique of EUS-Guided Drainage Using a LAMS
			15.3.10.1	 Selection and Route of the Drainage (Cyst-Gastrostomy or Cyst-Duodenostomy)
			15.3.10.2	 Efficacy of Transmural Endoscopic Drainage
		15.3.11 Adjunctive Therapies to Optimize Endoscopic Drainage
		15.3.12 Complications and Management
		15.3.13 Recurrence Rate
	15.4	 Conclusion
	References
16: Radiofrequency Ablation
	16.1	 What Is Radiofrequency Ablation?
	16.2	 Why Was Radiofrequency Ablation Used for Mucosal Ablation?
	16.3	 Who Are the Best Candidates for Radiofrequency Ablation in Barrett’s Esophagus?
	16.4	 How Is Radiofrequency Ablation Applied to Barrett’s Esophagus?
	16.5	 Treatment of Non-dysplastic Barrett’s Esophagus
	16.6	 Role of Radiofrequency Ablation of Low-Grade Dysplasia Barrett’s Esophagus
	16.7	 Radiofrequency Ablation for GAVE
	16.8	 Radiofrequency Ablation for Cholangiocarcinoma
	References
17: Peroral Endoscopic Myotomy
	17.1	 Introduction
	17.2	 Poem Technique [Fig. 17.1]
		17.2.1	 Short vs. Long Myotomy
		17.2.2	 Anterior vs. Posterior Myotomy
		17.2.3	 Full vs. Partial-Thickness Myotomy
		17.2.4	 Confirming Adequate Dissection on the Gastric Cardia
	17.3	 Poem Outcomes
		17.3.1	 Therapeutic Success
		17.3.2	 Perioperative Adverse Events (AEs)
	17.4	 Gastroesophageal Reflux After Poem
	17.5	 Conclusion
	References