Copyright â Springer - 2014
1: Diagnostic Techniques in Gastrointestinal Disease
1.1 Endoscopic Ultrasonography
1.1.2 Classification of Ultrasonic Endoscopes
1.1.2.1 Dedicated Ultrasonic Endoscopes
1.1.2.2 Transendosopic Miniature Ultrasonic Probes
1.1.2.3 Color Doppler Ultrasonic Endoscopes
1.1.2.4 Puncture-Intended Ultrasonic Endoscopes
1.1.3 Clinical Applications
1.1.3.1 TN Staging of Gastrointestinal Tumors
1.1.3.2 Diagnosis of Gastrointestinal Submucosal Tumors
1.1.3.3 Pancreato-Biliary System
1.1.3.4 EUS-Guided Fine Needle Aspiration Biopsy
Role of EUS-FNA in Diagnosing Esophageal Cancer
Role of EUS-FNA in Diagnosing Gastric Cancer
Role of EUS-FNA in Diagnosing Pancreatic Lesions
Role of EUS-FNA in Diagnosing SMTs
Role of EUS-FNA in Diagnosis of Rectal Cancer
1.1.3.5 Interventional EUS
Endosonography-Guided Cholangiopancreatography and Internal Drainage
EUS-Guided Neurolytic Celiac Plexus Neurolysis
EUS-Guided Puncture and Drainage of Pancreatic Cyst
EUS-Guided Radioactive Particle Implantation
1.2.1.1 Gross Morphology Classification
1.2.2 Application of NBI in Diagnosis of Barretts Esophagus
1.2.3 Application of NBI in Diagnosis of Early Esophageal Cancer
1.2.4 Application of NBI in Diagnosis of Early Gastric Cancer and Ampullary Cancer
1.2.5 Application of NBI in Diagnosis of Colorectal Mucosal Lesions
2: Device and Equipment for Endoscopic Therapy
2.1.1 Gastrointestinal Endoscopy
2.1.2 Electrosurgical Unit
2.1.2.1 Principle of Cutting and Coagulation
2.1.2.2 Monopolar and Bipolar Technology
2.1.2.3 Power Peak System (PPS)
2.1.3.1 Water Supply Equipment
2.1.4 Carbon Dioxide Insufflation
2.2.4 Retrieval Device for Resected Tissue
2.3 Endosurgical knives and accessories
2.3.1 IT Knife Insulated-tip (IT) Knife
2.3.4 Triangle Tip Knife (TT Knife)
2.4 Submucosal Injection Solution
2.4.2 Hypertonic Solution
2.4.4 Hyaluronic Acid (HA)
2.4.6 Future Injection Solution
2.4.6.1 Hydroxypropyl Methylcellulose (HPMC)
2.4.6.2 Carboxymethylcellulose (CMC)
2.4.6.3 Photocrosslinkable Chitosan Hydrogel in Medium
3: Endoscopic Mucosal Resection (EMR)
3.1.1 Indications and Contraindications
3.1.1.1 Indications and Patients Selection
3.1.1.2 Contraindications
3.1.2 Patient Preparation
3.1.2.1 General Information
3.1.2.2 Bowel Preparation
3.1.2.4 Equipment Preparation
3.1.2.5 Pre-operative Medication
3.1.3 Importance of the Assistant
3.1.4 Techniques for Resection
3.1.4.1 Polyps <0.5 cm in Size
3.1.4.2 Pedunculated Polyps
3.1.5 Techniques for Specimen Retrieval (Fig. 3.11)
3.1.6 Management of Complications
3.1.7 Post Polypectomy Management
3.2 Endoscopic Mucosal Resection
3.2.1 Indications and Contraindications
3.2.2 Equipment and Patient Preparation
3.2.2.1 Equipment for EMR
3.2.2.2 Injection Solution
3.2.2.3 Patient Preparation
3.2.3 Techniques and Skills for EMR
3.2.3.1 Injection Techniques
3.2.3.2 Inject and Cut Technique
3.2.3.3 Cap Assisted EMR Technique
3.2.3.4 EMR-Ligation Technique
3.2.3.5 Endoscopic Piecemeal Mucosal Resection (EPMR)Technique
3.2.3.6 Specimen Retrieval
3.2.4 Post-EMR Management
3.2.4.1 Management of Complications
3.2.4.2 Surveillance After EMR
4: Endoscopic Submucosal Dissection (ESD)
4.1 ESD for Superficial Esophageal Lesion
4.1.1 Indication [ 3, 4 ]
4.1.3 Preoperative Endoscopic Diagnosis
4.1.3.1 Lugol Iodine Staining
4.1.3.2 Narrow Band Imaging and Magnifying Endoscopy
4.1.4 Operating Procedure
4.1.4.2 Submucosal Injection
4.1.4.3 Mucosal Precutting
4.1.4.6 Pathological Evaluation
4.1.5 Postoperative Management and Follow-up
4.2 ESD for Early Gastric Cancer
4.2.2 Preoperative Endoscopic Diagnosis
4.2.3 Operating Procedure
4.2.3.1 ESD for Lesions at the Esophagogastric Junction
4.2.3.2 ESD for Lesions at the Gastric Antrum
4.2.3.3 ESD for Lesions at the Gastric Angle
4.2.3.4 ESD for Lesions at the Gastric Body
4.2.3.5 ESD for Lesions with Ulcer Scar
4.2.4 Postoperative Management and Follow-up
4.3 ESD for Colorectal Lesions
4.3.2 The Characteristics of ESD for Colorectal Cancer
4.3.4 Indications and Contraindications of ESD for Colorectal Cancer
4.3.4.2 Indications [ 22 ]
4.3.4.3 Contraindications
4.3.5 The Operation Approach of ESD for Colorectal Lesions
4.3.5.1 The Procedure and Skills of Colonic ESD
Confirming the Nature and Invasion Depth of Lesions
Histological Management of Resected Specimen
4.3.5.2 The Operating Approach of ESD for Low Rectal Lesions
Distinctive Features of Low Rectal ESD
4.3.6 The Application of Body Positions in Colorectal ESD
4.4 ESD of Recurrent/Residual Lesions After Previous EMR
4.4.1 Tumor Recurrence and Residual Tumor After Previous EMR
4.4.2 ESD for Tumor Recurrence/Residual After Previous EMR
Cases (Figs. 4.54, 4.55, 4.56, 4.57, 4.58, 4.59, 4.60, 4.61, 4.62, 4.63, 4.64, and 4.65)
4.4.2.2 Postoperative Management of ESD
4.4.2.3 Prevention and Treatment of Complications
4.5 Prevention and Management of Complications in ESD
4.5.1.1 Intraoperative Bleeding
4.5.2.1 Intraoperative Perforation
4.5.2.2 Delayed Perforation
4.5.3.1 Esophageal Stricture
4.6 Assistance and Cooperation
4.6.2 Arrangement of the OR
4.6.3.1 Preoperative Preparation and Anesthesia
4.6.3.2 Preparation of the Devices
4.6.3.3 Installation of Transparent Cap
4.6.3.7 Cutting and Dissection
4.6.3.11 Nylon-Ring Ligation
4.7 How I Do It: Endoscopic Submucosal Dissection
4.7.2 Instruments and Preparation
4.7.3 The Procedure of ESD
4.7.4 Management of Complications
5: Endoscopic Resection for Submucosal Tumors
5.1 Snare Polypectomy or Ligation Treatment of Submucosal Tumors
5.1.1.2 Equipment for Operation
5.1.1.3 Preoperative Evaluation
5.1.1.4 Operating Procedure
5.1.2 Ligation Therapy for GI SMTs
5.1.2.3 Treatment Options
5.2 Endoscopic Submucosal Excavation (ESE)
5.2.1 Preoperative Evaluation
5.2.4 Submucosal Injection
5.2.10 Prevention and Treatment of Complications
5.2.9 Postoperative Treatment and Follow-up
5.3 Endoscopic Full-Thickness Resection (EFTR)
5.3.2 Indications and Contraindications
5.3.3 Preoperative Preparations
5.3.4 Operational Approach
5.3.6 Metallic Clips Suture
5.3.7 An Omental-Patch Method
5.3.8 Metallic Clips Combined with Endoloop Suture
5.3.9 Repair Materials (Artificial Materials and Autologous Material, Figs. 5.48 and 5.49)
5.3.10 Closure Device Suture
5.3.10.2 Grasp-and-Snare [ 18 ] (Fig. 5.52)
5.3.10.3 Over-the-Scope Clips (OTSC) [ 19 ] (Fig. 5.53)
5.3.10.4 Surg ASSIST [ 21 ] (Fig. 5.54)
5.3.10.5 Tissue Anchor System [ 22 ] (Fig. 5.55)
5.3.10.6 Double Endoloop [ 23 ] (Fig. 5.56)
5.3.11 Case Illustrations of EFTR
5.3.11.2 Stomach (Figs. 5.60, 5.61, 5.62, 5.63, and 5.64)
5.3.11.3 Duodenum Figs. 5.65
5.3.11.4 Colorectum Figs. 5.66
5.3.12 Postoperative Management
5.3.13.2 Pneumoperitoneum
5.3.13.3 Peritonitis and Intra-ưabdominal Infections
5.3.13.4 Adjacent Organ Injury
5.4 Combined Endoscopic/Laparoscopic Therapy
5.4.1 Laparoscopic-Endoscopic Cooperative Surgery, LECS
5.4.1.1 Gastroscopic-Laparoscopic Cooperative Treatment to Cure Mucosal Gastric Cancer with the Potential Risk of Lymphatic Metastasis
5.4.1.2 Colonoscopic-Laparoscopic Cooperative Surgery to Cure Early Intestinal Cancer or Precancerous Lesions
Colonoscopy Assisted with Laparoscopic Treatment
Laparoscopic Resection of Intestinal Segments
Laparoscopy Assisted with Colonoscopy Treatment
5.4.1.3 Endoscopic Stenting Combined with Laparoscopic Colectomy to Treat Colon Cancer with Acute Intestinal Obstruction
5.4.2 Endoscopy Combined with Laparoscopy in the Treatment of GI SMTs
5.4.3 Thoracoscope Assisted Tunnel Endoscopic Resection
6: Tunnel Endoscopic Surgery
6.1 The Rise of Tunnel Endoscopic Surgery
6.2 Peroral Endoscopic Myotomy
6.2.3.1 Treatments Before POEM
6.2.3.2 Peroral Endoscopic Myotomy (POEM)
Circular Muscle Layer Myotomy Versus Complete Myotomy
Myotomy Orientation in Relation to LES
Evaluation of Treatment Success
Detection of Symptomatic Recurrences
Surveillance of Late Complications
Training and Accreditation
6.3 Submucosal Tunneling Endoscopic Resection (STER)
6.3.2 Equipment Used for STER
6.3.3 Examinations Before STER
6.3.3.1 Endoscopic Ultrasound (EUS) and/or EUS-Guided Fine Needle Aspiration (FNA)
6.3.3.2 Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI)
6.3.5 Special Cases (Figs. 6.38, 6.39, 6.40, 6.41, 6.42, 6.43, 6.44, and 6.45)
6.3.6 Pathologic Evaluation
6.4 Management of Complications
6.4.1 Intraoperative Complications
6.4.1.2 Intraoperative Gas-Related Complications
6.4.2 Postoperative Complications
6.4.2.1 Gas-Related Complications
6.4.2.3 Delayed Bleeding [ 29 ]
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