وصف
The "Therapeutic Endoscopy for the Non-Therapeutic Endoscopist" session is designed to provide gastroenterologists who may not regularly perform therapeutic procedures with valuable insights and hands-on skills in therapeutic endoscopy. This session focuses on practical aspects, including basic techniques for hemostasis, polypectomy, and foreign body removal, allowing participants to gain proficiency in therapeutic interventions. By bridging the gap between routine endoscopy and therapeutic procedures, this session aims to empower non-therapeutic endoscopists with the necessary knowledge and skills to enhance their clinical practice and contribute to comprehensive patient care within the field of Gastroenterology.
ملخص
- Lumen-apposing metal stents (LAMS), initially the Axios stent by Boston Scientific, have revolutionized ERCP and EUS procedures. They consist of a double-flanged stent that approximates two lumens, creating a conduit. The primary FDA-approved indication is for walled-off pancreatic fluid collections, offering high technical and clinical success.
- LAMS are favored over plastic stents due to their ease of deployment and comparable clinical outcomes. While drainage of pseudocysts is traditionally delayed for 4 weeks to allow wall formation, some data suggests earlier drainage is feasible for critically ill patients. Stent removal is recommended around 3-4 weeks to minimize complications like bleeding or stent impaction.
- LAMS are also used off-label for gallbladder drainage in high-risk surgical candidates. This approach, connecting the gallbladder to the small bowel or stomach, shows promising results when performed by experienced centers. Studies indicate lower adverse events and re-intervention rates compared to cholecystostomy.
- Gastrogastrostomy with LAMS is gaining traction for both malignant gastric outlet obstruction and benign pyloric stenosis. The procedure creates a bypass between the stomach and small bowel, potentially avoiding surgical intervention. While studies show benefits in stent patency and symptom relief, there is no difference in mortality compared to surgical approaches.
- Colangioscopy and pancreaticoscopy, utilizing single-use scopes like Spyglass and i-Max, allow direct visualization of the biliary and pancreatic ducts. These techniques are valuable for evaluating indeterminate strictures and obtaining targeted biopsies, leading to improved diagnostic accuracy compared to traditional ERCP and EUS.
- Radiofrequency ablation (RFA) is used to treat Barrett's esophagus and, increasingly, biliary and pancreatic tumors. In the biliary tract, RFA can be delivered via specialized probes during ERCP or through EUS-guided needles to ablate tumors and maintain stent patency. Recent studies demonstrate improved stent patency and reduced re-intervention rates when combining RFA with metal stents.
نموذج شهادة
حول المتحدثين
Jenan Ghaith
Consultant Gastroenterology, Pancreaticobiliary disease and Advanced Endoscopy, Cleveland Clinic, Abu Dhabi, UAE
الإفصاح المالي
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