AATS General Thoracic Skills Course Esophageal Disease Endoscopic and Minimally Invasive Techniques...
-
Upload
josephine-pope -
Category
Documents
-
view
224 -
download
1
Transcript of AATS General Thoracic Skills Course Esophageal Disease Endoscopic and Minimally Invasive Techniques...
AATS General Thoracic Skills CourseAATS General Thoracic Skills Course
Esophageal DiseaseEsophageal DiseaseEndoscopic and Minimally Invasive TechniquesEndoscopic and Minimally Invasive Techniques
Thomas Varghese Jr, MD, MSThomas Varghese Jr, MD, [email protected]
@tomvarghesejr@tomvarghesejr
April 25, 2015April 25, 2015
TopicsTopics
Endoscopic evaluation of Barrett’s Endoscopic evaluation of Barrett’s Endoscopic staging and Rx of Esophageal CancerEndoscopic staging and Rx of Esophageal Cancer
EMR, RFA, CryoEMR, RFA, Cryo
Minimally Invasive Treatment of Benign DiseaseMinimally Invasive Treatment of Benign Disease EndoscopicEndoscopic
POEM, Linx, Endoscopic Anti-RefluxPOEM, Linx, Endoscopic Anti-Reflux Laparoscopic PEH RepairLaparoscopic PEH Repair Stitch, Stents and ClipsStitch, Stents and Clips
Ross Bremner MD
Wayne Hofstetter MD
Daniel Miller MD
John Wee MD
Brian Louie MD
Hiran C. Fernando MD
Virginia Litle MD
Shanda Blackmon MD
Barrett’sBarrett’s
Risk Factor for Esophageal CancerRisk Factor for Esophageal Cancer Most will not develop cancerMost will not develop cancer No way to risk stratify at present with exception of No way to risk stratify at present with exception of
degrees of dysplasiadegrees of dysplasia
Biopsies unreliableBiopsies unreliable
Expense of surveillance very, very highExpense of surveillance very, very high
Esophageal CancerEsophageal Cancer
HGD to T1a Esophageal CancerHGD to T1a Esophageal Cancer What is the ideal treatment?What is the ideal treatment?
AchalasiaAchalasia
PerOral Endoscopic Myotomy (POEM)PerOral Endoscopic Myotomy (POEM) Laparoscopic Heller Myotomy + partial Laparoscopic Heller Myotomy + partial
fundoplicationfundoplication
J Laparoendosc Adv Surg Tech A. 2015;25(2):123-9Wei M1, Yang T, Yang X, Wang Z, Zhou Z.
No difference in complications, reflux, symptom recurrence No difference in complications, reflux, symptom recurrence
RefluxReflux
LINX™ SystemLINX™ System
Endoscopic Anti-Reflux ProceduresEndoscopic Anti-Reflux Procedures
Magnetic Sphincter Augmentation Magnetic Sphincter Augmentation (LINX™ System)(LINX™ System)
• Series of titanium covered magnets
• Roman Arch Design with magnets supported by “dumbell” shaped titanium wires
• Dynamic – opens and closes
• Fit to the outer circumference of the esophagus
Images courtesy of Torax Medical Inc.
Patient Selection
• Age 18+
• GERD
• Hiatal hernia < 3 cm
• No major dysmotility
• No visible Barrett’s esophagus
• BMI < 36 kg/m2
• No strictures
• No prior esophageal surgery
• No metal allergy
Paraesophageal HerniaParaesophageal Hernia
Laparoscopic ApproachLaparoscopic Approach Now the most commonNow the most common
Esophageal TearsEsophageal Tears
Stitch, Stent, ClipsStitch, Stent, Clips