Over the past decade enterprising endoscopists mostly from Asia have extended LBH589 nmr the technique of ESD to enucleation of SETs. However, the concern with using ESD to enucleate muscularis propria (MP)-based SETs such as GISTs is that tumor residua may remain in the muscularis propria. Novel superior closure devices and the innovative submucosal tunnel technique which allows secure closure after transluminal interventions such as per oral endoscopic myotomy (POEM) have led to development of endoscopic full thickness resection techniques for
SETs. Direct transmural endoscopic full thickness resection (EFTR) and submucosal tunnel endoscopic resection (STER), an offshoot of POEM, have been reported by few groups in Asia over the past year. We present three initial cases of complete endoscopic removal of muscularis based SETs of the gastroesophageal (GE) junction and cardia using EFTR in two and STER in one patient. The three videos presented may represent the first reported EFTR and STER procedures for SETs in the United States. Complete resection
was achieved in all patients with short procedure times and no significant adverse events. These excellent outcomes are probably in large part due to our prior extensive experience with POEM, clip closure techniques, I-BET-762 clinical trial and ESD for mucosal neoplasms as well as SETs. Unlike traditional ESD, EFTR and STER can achieve complete en bloc resection of MP-based SETs along with the associated MP thus ensuring R0 curative resection. These techniques represent a NOTES alternative to laparoscopic wedge resection. Advantages over laparoscopic
surgery include: 1. An incision-less approach and 2. Complete resection of SETs in areas that challenge laparoscopic resection such as the GE junction, esophagus and gastric cardia. “
“Gastric variceal hemorrhage (GVH) is a potentially life-threatening complication of portal hypertension. Cyanoacrylate injection achieves effective hemostasis in >90% of cases during GBA3 GVH. However, TIPS preferred as first-line treatment for GV hemorrhage in many centers. Barriers to use of tissue adhesive include lack of familiarity with injection technique, concern for glue embolization and its off-label use. Its been shown that risk of glue related complications increases when larger volumes of glue are injected. The current method of probing the varix to assess consistency as a way to determine hemostasis is subjective. We describe the use of audible Doppler ultrasound (DopUS) signal as an objective means of gauging the volume of glue needed to achieve hemostasis. 64 y/o man with cirrhosis presented with hematemesis. EGD performed and source of GI hemorrhage found to be GV. DopUS used to guide glue injection. Hemostasis achieved. Patient with no recurrent GV hemorrhage at 6 months.