Esophageal Stenting: Role in strictures, leaks, fistulae, and malignancy
|
|
- Loren Fleming
- 8 years ago
- Views:
Transcription
1 Esophageal Stenting: Role in strictures, leaks, fistulae, and malignancy Jasmine L. Huang, MD General Thoracic Surgery St. Joseph s s Hospital and Medical Center Phoenix, AZ
2 Jasmine Huang, MD I have no financial relationship with any manufacturer of any commercial product and/or provider of commercial services discussed in the CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product or device in my presentation. The planning committee for this event has no relevant financial relationships with commercial interest to disclose.
3 Outline The Ideal Stent Indications for stent placement Stenting for Malignancy Strictures Leak TEF Troubleshooting Future directions Recommendations
4 The Ideal Stent Does not leak Seals leaks Easy to retrieve Is not painful Does not cause reflux Allows a person to eat Does not cause stricture formation Compresses to a smaller size without infolding Easy to see under fluoroscopy Has just enough tissue ingrowth Has the ability to articulate with more stents Promotes healing Collagen matrix Growth factors Is easy to remove
5 Types of Stents Rigid plastic tubes Self-expanding expanding metals stents (SEMS) Uncovered Covered (csems( csems) Self-expanding expanding plastic stents (SEPS) Biodegradable
6 SEPS Polyflex (Polyethylene/Silicone) -Largest delivery system (13 mm)
7 SEMS Wallstents Z stents Gianturco Z (Stainless Steel/Polyurethane) Niti-S (Nitinol/Polyurethane) Esophacoil Alimaxx-E (Nitinol/Silicone) Ultraflex (Nitinol/Polyurethane) Wallflex (Nitinol/Polyurethane)
8 How to Stent 1. Endoscopy 2. Guidewire 3. Mark perforation as you withdraw 4. Remove scope 5. Place stent 6. Deploy
9 Indications for Stenting Dysphagia (esophageal/gastric cancer) Tracheo-esophageal fistula (TEF) Local recurrence Esophagectomy conduit Gastrectomy reconstruction Malignant
10 Indications for Stents Benign Perforation/leaks Anastomotic Post dilatation leak Boerhaave s syndrome Stricture Complex Caustic ingestion Radiation injury Anastomotic stricture Severe peptic injury
11 Stent Comparisons SEMS Advantages Lower migration rates Low profile delivery Disadvantages Difficult to remove Tumor/tissue ingrowth SEPS Advantages Removable Less tumor/tissue ingrowth Disadvantages High migration rates Thick, rigid deployment catheter
12 Procedure Related Complications Acute Perforation Aspiration pneumonia Fever Hemorrhage Severe pain Delayed Hemorrhage Fistula formation Stent migration Tumor/tissue ingrowth Food obstruction
13 SEPS > SEMS Location Risk Factors Stent Migration Distal and proximal > mid-esophageal Indication Peptic stricture > anastomotic > fistulas/leaks > postradiation strictures
14 In the setting of malignancy Why stents are useful Good palliation Dysphagia/wt loss most common presenting symptom Unresectable in 50% of pts at presentation Overall 5 yr survival < 10% Median survival in unresectable disease 3-6 mo Management of treatment complications Perforation post dilatation Anastomotic leaks/strictures Postradiation strictures Bridge to definitive therapy Stent prior to neoadjuvant therapy
15 ACG Practice Guidelines - Malignancy Malignant strictures and fistulas SEMS are superior to rigid plastic prosthesis in management of unresectable obstructive esophageal cancers SEMS > SEPS for malignancy (fewer complications) SEMS is treatment of choice for malignant fistula Sharma P and Kozarek R. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol 2010; 105:
16 Use of stenting in strictures
17 Type of stricture Simple Focal Straight Diameter that usually allows passage of normal diameter endoscope Usually can be treated with bougie or balloon dilation Common etiologies: peptic injury, Schatzki s ring/web
18 Type of stricture Complex Long, > 2 cm Tortuous Narrow diameter (< adult scope) Common causes: caustic ingestion, radiation injury, anastomotic stricture, severe peptic injury High recurrence rate with dilation, refractory to dilation
19 Results SEMS Approximately 50% recurrence rate Post radiation strictures more successful than peptic, anastomotic,, or achalasia Shorter strictures lower risk of recurring Tissue ingrowth noted SEPS Development of fully covered stents Migration rates higher Less ingrowth 40% long term success rate Siersema PD. Stenting for benign esophageal strictures.. Endoscopy 2009; 41:
20 ACG Practice Guidelines Benign Strictures SEMS Partially covered are not recommended or FDA approved for benign esophageal conditions SEPS Cannot be routinely recommended but strength of recommendation is weak Retrievable SEPS/SEMS/Biodegradable stents Encouraging results but recommend further studies
21
22
23
24
25
26 Management of Esophageal Leaks Gastric bypass Anastomotic leaks Boerhaave perforation Iatrogenic perforation Spontaneous cervical perforation
27 Esophageal Stenting for Anastomotic Leaks Roy-Choudry, 2001, n=14, healing 13/14 (93%)EG Fernandez, 2010, n=4, healing 3/ 4(75%)EJ Dai, 2010, n=30, healing 27/30 (90%) EJ Schweigert, 2011, healing 9/12 (85%) EG Freeman, 2007, n=5, healing 4/5(80%) EG Blackmon, 2010 n=13, healing 12/13 (94%) EJ +EG Roy-Choudry SH, et al. AJR January 2001, 176, Fernandez A. Rev Esp Enferm Dig Dec;102(12): Dai Y, Chopra S, KneifS, HunerbeinM. J ThoracCardiovascSurg Dec 15 Schweigert M et al. Interact Cardiovasc Thorac Surg Feb;12(2): Freeman R, AsciotiA, WoznaikTC. JTCVS Feb;133(2): Blackmon SH. Et al Ann Thorac Surg Mar;89(3):931-6; discussion
28 Esophageal Stenting for Leaks The advantage of esophageal stenting with leaks and fistulas is the salvage of an optimal conduit - saving the esophagus is key Blackmon SH, Santora R, Schwarz P, Barroso A, Dunkin BJ. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Annals of Thoracic Surgery, 2010;89:931-7.
29 Esophageal Stenting for Leaks Still have to drain infection HAVE to see the leak Still have to decorticate lung Can heal leaks as large as 5cm long Know when to stop stenting Stent-guided re-epithelialization may lessen strictures once healed Hybrid procedures still performed Muscle flaps when in chest augment healing
30 Esophageal Stenting for Anastomotic Leaks Make sure the conduit is viable Must sleeve the entire conduit if large gastric conduit is made May lessen stricture after leak heals? Scaffold for re-epithelialization
31
32
33
34
35
36
37
38 Esophageal Stenting for Iatrogenic Perforation Freeman, 2007 n=17 healed 16/17 (94%) van Heel, 2010 n=19 healed 18/19 Many small case reports in the literature Freeman RK, Van WoerkomJM, AsciotiAJ. Ann ThoracSurg Jun;83(6): Van Heel et al. Am J Gastroenterol Jul;105(7):
39 Esophageal Stenting for Iatrogenic Perforation Majority are from dilations The earlier you stent, the better the outcome Many can be observed If the leak does not heal, think cancer
40 ACG Practice Guidelines - Leak SEMS and SEPS can be considered in treatment of perforation, leaks, and fistulas Strength of recommendation is weak
41 Acquired TEF Benign Post intubation Inflammatory Wegener s s granulomatosis Tb, syphilis, actinomycosis, histoplasmosis, aspergillus, candida Trauma Blunt Compression Rupture Penetrating Often assoc with lethal great vessel injuries Burns and caustic injuries Foreign bodies Impacted disc battery Fish bones Malignant Esophageal cancer Lung cancer Tracheal cancer Laryngeal cancer Lymphoma
42 Malignant Acquired TEF Management Airway/esophageal stents for palliation Prevent ongoing pulmonary soilage Restore swallowing Staged surgical repair after curative therapy (ie lymphoma)
43 Esophageal Stents for TEF Only the successes are reported Cook TA. DehnTC. Use of covered expandable metal stents in the treatment of oesophagealcarcinoma and tracheo-oesophagealfistula. British Journal of Surgery. 83(10):1417-8, 1996 Oct. EllulJP. Morgan R. Gold D. DussekJ. Mason RC. Adam A. Parallel self-expanding covered metal stents in the trachea and oesophagus for the palliation of complex high tracheooesophagealfistula. British Journal of Surgery. 83(12):1767-8, 1996 Dec. HramiecJE. O'Shea MA. Quinlan RM. Expandable metallic esophageal stents in benign disease: a cause for concern. Surgical Laparoscopy & Endoscopy. 8(1):40-3, 1998 Feb. Zaki HS. Studer SP. Kharchaf M. Myers EN. Prosthetic obturation of tracheoesophageal fistula. Laryngoscope. 111(2):359-60, 2001 Feb.
44 Troubleshooting
45
46 Problem Solving Migration of the Stent Summary of migration issues: Migration is more pronounced when covering the UES Migration also happens more frequently at the lower esophagus Stricture vs. leak
47 Problem Solving Migration of the Stent Umbilical tape: One end out R nostril The other out L nostril Bridling of the stent: Solutions #1: Bridging the stents together Solution #2: Suture fixation
48 Migration Esophageal pexy Used for UES stents carotid track suture passer must follow to avoid arterial injury trachea Stent in esophagus pexy as it appears after endoscopy
49 Pexy of Esophageal Stent Using Gore-Tex Pledget
50 Esophageal Stents Unique Problems Stent folding Solution #1: balloon dilation Solution #2: swallow test for efficacymay not have to do anything Solution #3: replace with csems that will not fold
51 Pain Esophageal Stents Unique Problems Appears to be worse in benign disease than malignant Another reason why removable stents may be better even in malignant cases Solution: pain medication versus baclofen versus removal
52 Esophageal Stents Unique Problems Granulation Tissue and In-growth Removal may be difficult (especially with the metal stents, thus do not place them for benign disease) Solution: mechanical debridement or freezing may also be an option
53 Esophageal Stents Unique Problems Granulation Tissue and In-growth Solutions: endoscopy around the stent first, rigid esophagoscopy
54 GERD Esophageal Stents Unique Problems Solution #1: cut a v in the bottom of the polyflex stent on opposite sides to allow in-folding at the bottom and prevent reflux Solution #2: Antireflux/Heimlich valve has been built into the stent Solution #3: G Tube or NGT to decompress (beware of suctioning the stent too much!)
55 What is the future of esophageal stenting? Collagen matrix on the outside of the stent (Takimoto et al.) Collagen sponge to promote healing (Yamamoto et al.) Better retrieval devices (Yoon et al.) Biodegradable stents (Saito et al.) Brachytherapy seeds loaded within the stents (Guo et al.)
56 Biodegradable Stents Biodegradable poly-l-lactic acid (PLLA) esophageal stents (n=2) with benign esophageal stenosis after endoscopic submucosal dissection (ESD). After balloon dilatation, the PLLA esophageal stents were endoscopically placed. Due to the biodegradable features of this stent, longer term studies are necessary to investigate the relationship between the expected disappearance of the stent and the patency of the stricture. Saito Y. et al. Digestive Diseases & Sciences. 53(2):330-3, 2008 Feb.
57 Brachytherapy Stents Randomized, case-controlled trial of self-expandable esophageal stent loaded with I 125 seeds for intraluminal brachytherapy versus the response to treatment with a conventional csems in patients with advanced esophageal cancer. Stent Type: n dysphagia Hemorrhage Survival improvement Radiation stent 27 R>C, (p<.05) R>C, (p<.001) Control stent 26 Both 16(30%) Guo JH. Teng GJ. Zhu GY. He SC. Fang W. Deng G. Li GZ. Radiology. 247(2):574-81, 2008 May.
58 Brachytherapy Stents In patients with advanced esophageal cancer, treatment with an esophageal stent loaded with I 125 seeds has a slightly longer relief of dysphagia and extended survival compared to a conventional stent. Guo JH. Teng GJ. Zhu GY. He SC. Fang W. Deng G. Li GZ. Radiology. 247(2):574-81, 2008 May.
59 What other options are being explored for esophageal fistulas?
60 Role in leaks Recommendations Choice of treatment is dependent on cause and location of injury, underlying esophageal disease, interval of time to diagnosis and treatment Treatment is still controversial but stenting is increasingly being utilized Primary repair is still preferable when able Role for stenting seen in: Thoracic-abdominal abdominal perforations which are within a healthy esophagus and are contained Inoperable malignancy High risk surgical candidate Post-surgical surgical anastomotic leaks Studies are retrospective
61 Role in malignancy Recommendations Palliation Management of treatment complications Perforation post dilatation Anastomotic leaks/strictures Postradiation strictures Bridge to definitive therapy Stent prior to neoadjuvant therapy
62 Role in benign stricture Recommendations Refractory strictures Consider location and etiology of stricture when deciding on type of stent Stent placed for 4 weeks up to 4 months depending on the type of stent used Surveillance endoscopies at least every 4 weeks are recommended
63 Esophageal Stenting The Future Vac sponge? Biodegradable stents Endoscopic suturing devices Randomized trials comparing available treatment options CernaM et al. Covered Biodegradable Stent: New Therapeutic Option for the Management of Esophageal Perforation or AnastomoticLeak. CardiovascInterventRadiol Jan 7.
64
Endoscopic therapy for obesity and complications of bariatric surgery
Endoscopic therapy for obesity and complications of bariatric surgery Jacques Devière, MD, PhD Erasme University Hospital Brussels Belgium jacques.deviere@erasme.ulb.ac.be Obesity Affects 300 millions
More informationEndoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center
Endoscopic Management of Strictures and Leaks Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center What can go wrong? Bleeding (2%) Sleeve too big Angulated Too
More informationWallFlex Biliary RX Stent. Fully, Partially and Uncovered Self-Expanding Metal Stents
WallFlex Biliary RX Stent Fully, Partially and Uncovered Self-Expanding Metal Stents WallFlex Biliary RX Stent Fully, Partially and Uncovered Self-Expanding Metal Stents The WallFlex Biliary RX Stent is
More informationUse of stents in esophageal cancer" Hans Gerdes, M.D. Director, GI Endoscopy Unit Memorial Sloan-Kettering Cancer Center
Use of stents in esophageal cancer" Hans Gerdes, M.D. Director, GI Endoscopy Unit Memorial Sloan-Kettering Cancer Center Features of esophageal cancer Esophageal cancer is an abnormal growth that arises
More informationBenign Esophageal Perforations: Better Keep a Surgeon in the Toolkit
Benign Esophageal Perforations: Better Keep a Surgeon in the Toolkit Bryan F. Meyers MD MPH Patrick and Joy Williamson Professor of Surgery Background Esophageal perforation is a difficult problem to characterize,
More informationUSE OF STENTS FOR UPPER GI DISASTERS. Michael Talbot. The St George Hospital, Sydney
USE OF STENTS FOR UPPER GI DISASTERS Michael Talbot. The St George Hospital, Sydney Disclosures Educational grants by Coviden, Applied Medical, Endogastric Solutions and Allergan in the last 3 years Clinical
More informationCancer of the Cardia/GE Junction: Surgical Options
Cancer of the Cardia/GE Junction: Surgical Options Michael A Smith, MD Associate Chief Thoracic Surgery Center for Thoracic Disease St Joseph s Hospital and Medical Center Phoenix, AZ Michael Smith, MD
More informationContraindications: Malign or benign strictures in the upper part of esophagus close to the cricopharyngeal muscle.
Manufactured by: ELLA CS, s.r.o. Milady Horákové 504 500 06 Hradec Králové 6 Czech Republic Phone: +420 49 527 91 11 Fax: +420 49 526 56 55 E-mail: volenec@ellacs.cz Instructions for Use FerX-ELLA Esophageal
More informationSurgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of
Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of Surgery & Associate Residency Program Director UC Irvine
More informationPreoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany
Preoperative drainage is always indicated in malignant CBD strictures PRO Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Background Jaundice is associated with high perioperative morbidity
More information11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation
I have nothing to Disclose Ramsey Dallal, MD, FACS Vice Chair Department of Surgery Chief Bariatric i and Minimally i Invasive Surgery Einstein Healthcare Network Nemacolin, PA 2014 Covered Stents discussed
More informationAcute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose
Acute Abdominal Pain following Bariatric Surgery Kathy J. Morris, DNP, APRN, FNP C, FAANP University of Nebraska Medical Center College of Nursing Disclosure I have nothing to disclose Objectives Pathophysiology
More informationEvolution of Barrett s esophagus
Endoscopic Treatment and Surveillance of Esophageal Cancer: GI Perspective Charles J. Lightdale, MD Columbia University New York, NY Evolution of Barrett s esophagus Squamous esophagus Chronic inflammation
More informationWhat is Barrett s esophagus? How does Barrett s esophagus develop?
Barrett s Esophagus What is Barrett s esophagus? Barrett s esophagus is a pre-cancerous condition affecting the lining of the esophagus, the swallowing tube that carries foods and liquids from the mouth
More informationDept. of Medical Imaging University of Ottawa
ED Visits Related to Bariatric Surgery: Review of Normal Post-Surgical Anatomy as Well as Complications Dept. of Medical Imaging University of Ottawa Disclosures Background Roux-en-Y Gastric Bypass Surgery
More informationWhat is the Sleeve Gastrectomy?
What is the Sleeve Gastrectomy? The Sleeve Gastrectomy (also referred to as the Gastric Sleeve, Vertical Sleeve Gastrectomy, Partial Gastrectomy, or Tube Gastrectomy) is a relatively new procedure for
More informationOpen Ventral Hernia Repair
Ventral Hernias Open Ventral Hernia Repair UCSF Postgraduate Course in General Surgery Maui, HI March 21, 2011 Hobart W. Harris, MD, MPH Ventral Hernias: National Experience Occur following 11-23% of laparotomies,
More informationLaparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds
Laparoscopic Repair of Incisional Hernia Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Overview Definition Advantages of Laparoscopic Repair Disadvantages of Open Repair
More informationOverview of Bariatric Surgery
Overview of Bariatric Surgery To better understand how weight loss surgery works, it is helpful to know how the normal digestive process works. As food moves along the digestive tract, special digestive
More informationAORTOENTERIC FISTULA. Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005
AORTOENTERIC FISTULA Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA diagnosis and management Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA Aortoenteric
More informationTypes of Bariatric Procedures. Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012
Types of Bariatric Procedures Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012 A Brief History of Bariatric Surgery First seen in pts with short bowel syndrome weight loss First
More informationGASTROESOPHAGEAL REFLUX DISEASE (GERD)
GASTROESOPHAGEAL REFLUX DISEASE (GERD) Gastroesophageal reflux disease is a clinical scenario where the gastric or duodenal contents reflux back up into the esophagus. Reflux esophagitis, however, is a
More informationSAGES 2015 Flexible Endoscopy Course for Fellows
Goals and Objectives: At the end of the course, the MIS fellow will be familiar with GI endoscopes, towers, and the instruments used for endoscopy and endoscopic surgery. The fellow will also be able to
More informationPATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS
As a patient you must be adequately informed about your condition and the recommended surgical procedure. Please read this document carefully and ask about anything you do not understand. Please initial
More informationNutritional Management in Esophageal Cancer. Kurt Boeykens Nutrition Nurse Specialist
Nutritional Management in Esophageal Cancer Kurt Boeykens Nutrition Nurse Specialist 1 Are these patients nutritionally at risk? If surgery: Major surgery Preoperative treatment Chemotherapy and radiation
More informationBreast Reconstruction Options. Department of Plastic Surgery #290 Santa Clara Homestead Campus
Breast Reconstruction Options Department of Plastic Surgery #290 Santa Clara Homestead Campus Importance of Breast Reconstruction As successes in treating breast cancer have grown, more women have been
More informationPOEM Procedure for. Esophageal Achalasia
POEM Procedure for Esophageal Achalasia POEM (Per-Oral endoscopic myotomy) is an incisionless procedure to treat esophageal achalasia, totally performed by endoscopy, without cutting the surface of the
More informationImaging of Thoracic Endovascular Stent-Grafts
Imaging of Thoracic Endovascular Stent-Grafts Tariq Hameed, M.D. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana Disclosures: No relevant financial
More informationEvidence tabel Lokaal palliatieve behandelingen
Auteurs, jaartal Mate van bewijs Studie type Follow-up Populatie (incl. steekproef-grootte) Patienten kenmerken Interventie Controle Resultaten Conclusie Opmerkingen, commentaar Hartgrink, 2002 The Netherlands
More informationEndovascular Repair of an Axillary Artery Aneurysm: A Novel Approach
Endovascular Repair of an Axillary Artery Aneurysm: A Novel Approach Bao- Thuy D. Hoang, MD 1, Jonathan- Hien Vu, MD 2, Jerry Matteo, MD 3 1 Department of Surgery, University of Florida College of Medicine,
More informationThe hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass
ORIGINAL ARTICLE Annals of Gastroenterology (2015) 28, 1-6 The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass Katherine Arndtz a, Helen Steed b, James Hodson
More informationEndoluminal Bariatric Revision. Todd David Wilson, MD
Endoluminal Bariatric Revision Todd David Wilson, MD Surgical Endoscopy and the Bariatric Surgeon Preoperative Endoscopy Postoperative Endoscopy Revisional Endoscopy Primary Endoluminal Bariatrics Preoperative
More informationInformed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name
Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Vertical Sleeve
More informationWeight Loss before Hernia Repair Surgery
Weight Loss before Hernia Repair Surgery What is an abdominal wall hernia? The abdomen (commonly called the belly) holds many of your internal organs. In the front, the abdomen is protected by a tough
More informationWhen, Why, and How to Revise a Failed Sleeve Gastrectomy
When, Why, and How to Revise a Failed Sleeve Gastrectomy Jin S. Yoo M.D. Assistant Professor of Surgery Duke University Medical Center April 6, 2013 When and Why Already Covered Let s Talk About How Overview
More informationA Practical Guide to Advances in Staging and Treatment of NSCLC
A Practical Guide to Advances in Staging and Treatment of NSCLC Robert J. Korst, M.D. Director, Thoracic Surgery Medical Director, The Blumenthal Cancer Center The Valley Hospital Objectives Revised staging
More informationERCP in Post Surgical Anatomy
ERCP in Post Surgical Anatomy ACG Western Regional Course, 2013 John G. Lee, MD Division of Gastroenterology University of California, Irvine Medical Center Common surgical alterations Intact pancreaticobiliary
More informationEndoscopic Therapy for Early Esophageal Cancer: EMR and ESD
Endoscopic Therapy for Early Esophageal Cancer: EMR and ESD AATS Toronto April 26, 2014 Lorenzo Ferri MD PhD David S. Mulder Chair in Surgery Associate Professor of Surgery and Oncology Disclosures Olympus
More informationEmerging Concepts in Bariatric Surgery
Emerging Concepts in Bariatric Surgery C Y N T H I A L. L O N G, M D, F A C S S I N A I H O S P I T A L O F B A L T I M O R E D E P A R T M E N T O F S U R G E R Y D I V I S I O N O F M I N I M A L L Y
More informationLearning Luncheon 7: Endoscopic Mucosal Resection: When, Where and How?
Endoscopic Mucosal Resection (EMR): When, Where, and Charles J. Lightdale, MD Columbia University New York, NY Endoscopic Mucosal Resection (EMR) EMR developed for removal of sessile or flat neoplasms
More informationBenign Gastro-bronchial Fistula. An Uncommon Complication of Esophagectomy: Case Report
Benign Gastro-bronchial Fistula An Uncommon Complication of Esophagectomy: Case Report Mohan P Devbhandari 1 Rohit Jain 1 Simon Galloway 2 Peter Krysiak 1 mohandev@hotmail.com rohitjain@hotmail.co.uk Simon.Galloway@smuht.nwest.nhs.uk
More informationThoracoabdominal aortic aneurysm
Thoracoabdominal aortic aneurysm Patient (1) - 69 PMH: 2013 - MVP, aortic root replacement with biological valve (Perimount) and subtotal aortic arch replacement Analysis for oppressive chest complaints
More informationColocutaneous Fistula. Disclosures
Colocutaneous Fistula Madhulika G. Varma MD Associate Professor Chief, Colorectal Surgery University of California, San Francisco Honoraria Applied Medical Covidien Disclosures 1 Colocutaneous Fistula
More informationHow to Effectively Code for Endoscopic Procedures in Gastroenterology
How to Effectively Code for Endoscopic Procedures in Gastroenterology Ariwan Rakvit, MD Associate Professor Interim Chief, Division of Gastroenterology Texas Tech University Health Science Center All rights
More information2014 Procedural Reimbursement Guide for Endoscopy
2014 Procedural Reimbursement Guide for Endoscopy 2014 Procedural Reimbursement Guide For THIS PROCEDURAL REIMBURSEMENT GUIDE, FOR SELECT ENDOSCOPY PROCEDURES, provides coding and reimbursement information
More informationLaser Therapy and Airway Stenting for Central-Type Lung Cancer
Lung Cancer Laser Therapy and Airway Stenting for Central-Type Lung Cancer JMAJ 46(12): 547 553, 2003 Kinya FURUKAWA*, Komei KINOSHITA**, Takamoto SAIJO***, Takeshi HIRATA***, Hisashi SAJI*** and Harubumi
More informationEndoscopic treatment of Common Esophageal disorders
Endoscopic treatment of Common Esophageal disorders November 7, 2015 Shivangi T. Kothari, MD Assistant Professor, Medicine Associate Director of Endoscopy Co-Director Developmental Endoscopy Lab at UR
More informationEndoscopic Resection for Barrett s Esophagus and Early Cancer 2014 Masters of Minimally Invasive Surgery
Endoscopic Resection for Barrett s Esophagus and Early Cancer 2014 Masters of Minimally Invasive Surgery Matthew Hartwig, M.D. Duke Cancer Institute Case Presentation: Patient ER 51 y/o man with schizophrenia
More informationClinical Indications and Results Following Chest Wall Resection
Clinical Indications and Results Following Chest Wall Resection for Recurrent Malignant Pleural Mesothelioma Ali SO, Burt BM, Groth SS, DaSilva MC, Yeap BY, Richards WG, Baldini EH and Sugarbaker DJ. Division
More informationRadiation Therapy in the Treatment of
Lung Cancer Radiation Therapy in the Treatment of Lung Cancer JMAJ 46(12): 537 541, 2003 Kazushige HAYAKAWA Professor and Chairman, Department of Radiology, Kitasato University School of Medicine Abstract:
More informationFigure 2: Recurrent chest pain of suspected esophageal origin
Figure 2: Recurrent chest pain of suspected esophageal origin 1 patient with chest pain of suspected esophageal origin 2 history and physical exam. suggestive of n-esophageal etiology? 3 evaluate and treat
More informationTRACHEOSTOMY TUBE PARTS
Page1 NR 33 TRACHEOSTOMY CARE AND SUCTIONING Review ATI Basic skills videos: Tracheostomy care and Endotracheal suction using a closed suction set. TRACHEOSTOMY TUBE PARTS Match the numbers on the diagram
More informationEarly Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D.
Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D. Professor of Medicine Germanis Kaufman Chair of Gastroenterology Director, Dept. of Gastroenterology Chaim Sheba Medical Center,
More informationLaparoscopic Hernia Repair. Hernia Repair. Laparoscopic Ventral. Several Different Types of Hernia
Laparoscopic Hernia Repair David B Renton, MD Assistant Professor Department of Surgery The Ohio State University Advantages of Laparoscopic Ventral vs. Open Hernia Repair Lower wound infection rate: 2.6%
More informationCORROSIVE INGESTION INJURIES. Dr L Fourie Moderator Prof. Mokoena
CORROSIVE INGESTION INJURIES Dr L Fourie Moderator Prof. Mokoena OVERVIEW Definition Pathophysiology Acute phase management and classification. Management and prevention of late sequelae Conclusion DEFINITION
More informationRecurrent & Persistent Papillary Thyroid Cancer Central Nodal Dissection vs. Node-Picking Patterns of Nodal Metastases Recurrent Laryngeal Nerve,
Recurrent & Persistent Papillary Thyroid Cancer Central Nodal Dissection vs. Node-Picking Patterns of Nodal Metastases Recurrent Laryngeal Nerve, Larynx, Trachea, & Esophageal Management Robert C. Wang,
More informationA Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair
A Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair Table of Contents The AFX Endovascular AAA System............................................ 1 What is an Abdominal Aortic Aneurysm
More informationGeneral Thoracic Surgery ICD9 to ICD10 Crosswalks. C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
ICD-9 Code ICD-9 Description ICD-10 Code ICD-10 Description 150.3 Malignant neoplasm of upper third of esophagus C15.3 Malignant neoplasm of upper third of esophagus 150.4 Malignant neoplasm of middle
More informationChristopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona
Christopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona Areas to be covered Historical, current, and future treatments for various cardiovascular disease: Atherosclerosis (Coronary
More informationValk J.W., Gypen B., Abdelgabar A., Hendrickx L. Schijns W., Aarts E., Janssen I., Berends F. Rheinwalt K.P., Schneider S., Plamper A.
Revisional Surgery for Weight Regain or Insufficient Weight Loss after Gastric Bypass using the Minimizer Ring: Short Term Results of a Multi Center Study Valk J.W., Gypen B., Abdelgabar A., Hendrickx
More informationCongenital Diaphragmatic Hernia. Manuel A. Molina, M.D. University Hospital at Brooklyn SUNY Downstate
Congenital Diaphragmatic Hernia Manuel A. Molina, M.D. University Hospital at Brooklyn SUNY Downstate Congenital Diaphragmatic Hernias Incidence 1 in 2000 to 5000 live births. 80% in the left side, 20%
More informationEndoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery
Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Authors: Chiranjiv S Virk, I Michael Leitman and Elliot R Goodman. Location: Beth Israel
More informationWhy a loop and new approach makes sense!
IP: tomach Intestinal Pylorus paring urgery Why a loop and new approach makes sense! Mitchell Roslin, MD, FAC Chief of Bariatric and Metabolic urgery Lenox Hill Hospital Northern Westchester Hospital Center
More informationSpinal Cord Stimulation (SCS) Therapy: Fact Sheet
Spinal Cord Stimulation (SCS) Therapy: Fact Sheet What is SCS Therapy? Spinal cord stimulation (SCS) may be a life-changing 1 surgical option for patients to control their chronic neuropathic pain and
More informationSome V Codes You Should Know About But not necessarily use SAMPLE. Lisa Selman Holman JD, BSN, RN, HCS D, COS C
Some V Codes You Should Know About But not necessarily use Lisa Selman Holman JD, BSN, RN, HCS D, COS C For the exclusive use of HCIN subscribers 1 Download Handouts If you have not already downloaded
More informationBC Children s Hospital Emergency Room Clinical Practice Guidelines. Ingested Foreign Bodies
BC Children s Hospital Emergency Room Clinical Practice Guidelines Ingested Foreign Bodies AUTHORS: Navid Dehghani, MD, FRCRC Division of Pediatric Emergency Medicine Department of Pediatrics, University
More informationBrachytherapy improved dysphagia more than stenting in people with inoperable oesophageal cancer
CANCER TREATMENT REVIEWS (2005) 31, 230 235 www.elsevierhealth.com/journals/ctrv EVIDENCE-BASED ONCOLOGY Brachytherapy improved dysphagia more than stenting in people with inoperable oesophageal cancer
More informationOVER 45 YEARS TEXTILE GRAFT TECHNOLOGY EXPERIENCE MAQUET THE GOLD STANDARD
OVER 45 YEARS TEXTILE GRAFT TECHNOLOGY EXPERIENCE MAQUET THE GOLD STANDARD A comprehensive, proven vascular graft portfolio and exceptional professional support make MAQUET Cardiovascular a valuable asset
More informationResection, Reduction, and Revision of Aneurysmal AV Fistulas
Resection, Reduction, and Revision of Aneurysmal AV Fistulas Patrick R. Cook DO, FACS Timothy G. Canty Jr. MD Robert J. Hye MD, FACS Kaiser Permanente San Diego, CA Aneurysmal AVF Over last decade K-DOQI
More informationTreatment for severe GERD after Sleeve Gastrectomy: conversion to gastric bypass or endoluminal radiofrequency. Alfonso Torquati, MD, MSCI, FACS
Treatment for severe GERD after Sleeve Gastrectomy: conversion to gastric bypass or endoluminal radiofrequency. Alfonso Torquati, MD, MSCI, FACS Associate Professor and Chief Division of Metabolic and
More informationRadiotherapy in locally advanced & metastatic NSC lung cancer
Radiotherapy in locally advanced & metastatic NSC lung cancer Dr Raj Hegde. MD. FRANZCR Consultant Radiation Oncologist. William Buckland Radiotherapy Centre. Latrobe Regional Hospital. Locally advanced
More informationThe digestive system. Medicine and technology. Normal structure and function Diagnostic methods Example diseases and therapies
The digestive system Medicine and technology Normal structure and function Diagnostic methods Example diseases and therapies The digestive system An overview (1) Oesophagus Liver (hepar) Biliary system
More informationNon-surgical treatment of severe varicose veins
Non-surgical treatment of severe varicose veins Yasu Harasaki UCHSC Department of Surgery General Surgery Grand Rounds March 19, 2007 Definition Dilated, palpable, subcutaneous veins generally >3mm in
More informationGastrointestinal Bleeding
Gastrointestinal Bleeding Introduction Gastrointestinal bleeding is a symptom of many diseases rather than a disease itself. A number of different conditions can cause gastrointestinal bleeding. Some causes
More informationEndoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009
Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy M. Arvanitakis SRBG June 2009 Outline Antibiotic prophylaxis during endoscopy Upper GI endoscopy Lower
More informationInformed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name
Informed Consent for Laparoscopic Roux en Y Gastric Bypass Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Roux en Y Gastric
More informationBreast Reconstruction Frequently Asked Questions
Breast Reconstruction Frequently Asked Questions GENERAL Do I need to have breast reconstruction? It is never medically necessary to have breast reconstruction. This is considered an elective procedure,
More informationRoux-en-y gastric bypass - clinical perspectives
Roux-en-y gastric bypass - clinical perspectives Tom Mala Consultant surgeon Department of Gastroenterologic Surgery Oslo University Hospital Bariatric surgery weight loss Sjøstrøm L, JAMA 2012 Five-year
More informationNew treatment options for chronic sinusitis
New treatment options for chronic sinusitis Balloon Sinuplasty Technology Vishram Jalukar, MD Mason City Clinic ENT & Allergy MKT01014 Rev. D Sinusitis Overview Inflammation of the sinus lining caused
More informationClinical Practice Assessment Robotic surgery
Clinical Practice Assessment Robotic surgery Background: Surgery is by nature invasive. Efforts have been made over time to reduce complications and the trauma inherently associated with surgery through
More informationSurgical Treatment of Obesity: A Surgeon s View
Surgical Treatment of Obesity: A Surgeon s View Jenny J. Choi, MD Director of Bariatrics Associate Director of Clinical Affairs Assistant Professor of Surgery Albert Einstein School of Medicine Montefiore
More informationCPT COD1NG UPDATES Gastroenterology CPT Advisors
2014 CPT COD1NG UPDATES Gastroenterology CPT Advisors Joel V. Brill, MD, AGA CPT Advisor Daniel C. DeMarco, MD, ACG CPT Advisor Glenn D. Littenberg, MD, ASGE CPT Advisor The American College of Gastroenterology
More informationCORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ. Charles White MD
CORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ Charles White MD Director of Thoracic Imaging Department of Radiology University of Maryland CORONARY ARTERY BYPASS GRAFTS First performed
More informationEmergencies in Post- Bariatric Surgery Patients
Emergencies in Post- Patients Disclosures Dr. Birnbaumer has no financial disclosures Diane M. Birnbaumer, M.D., FACEP Professor of Medicine University of California, Los Angeles Senior Clinical Educator
More informationRetrograde Balloon Dilation of Complete Cervical Esophageal and Hypopharyngeal Strictures
ARTICLE Retrograde Balloon Dilation of Complete Cervical Esophageal and Hypopharyngeal Strictures Lance E. Oxford, MD, and Yadranko Ducic, MD, FRCSC, FACS ABSTRACT Objectives: To evaluate and describe
More informationOptimal Management of Splenic/Portal Vein Thrombosis. David Mauchley University of Colorado
Optimal Management of Splenic/Portal Vein Thrombosis David Mauchley University of Colorado Overview Portal Vein Thrombosis (PVT) Etiology Presentation/Clinical Aspects Diagnosis Management Cirrhotic vs.
More informationCaptivator EMR Device
Device Clinical Article and Abstract Summary Endoscopic Mucosal Bergman et al: EMR Training Tips Bergman et al: EMR Learning Curve ASGE: EMR & ESD Guidelines Bergman et al: Captivator EMR vs Cook Duette
More informationThe Need for Accurate Lung Cancer Staging
The Need for Accurate Lung Cancer Staging Peter Baik, DO Thoracic Surgery Cancer Treatment Centers of America Oklahoma Osteopathic Association 115th Annual Convention Financial Disclosures: None 2 Objectives
More informationPatient Information Booklet. Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms
Patient Information Booklet Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms TABLE OF CONTENTS Introduction 1 Glossary 2 Abdominal Aorta 4 Abdominal Aortic Aneurysm 5 Causes 6 Symptoms
More informationSurgeons Role in Symptom Management. A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND
Surgeons Role in Symptom Management A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND Conditions PLEURAL Pleural effusion Pneumothorax ENDOBRONCHIAL Haemoptysis
More informationGastroesophageal Reflux Disease (GERD) and Barrett s Esophagus (BE)
Gastroesophageal Reflux Disease (GERD) and Barrett s Esophagus (BE) Hashem El-Serag, M.D., M.P.H. Dan L. Duncan Professor of Medicine Chief, Gastroenterology and Hepatology Baylor College of Medicine Houston,
More informationUNMH Cardiothoracic Surgery Clinical Privileges
All new applicants must meet the following requirements as approved by the UNMH Board of Trustees effective: 02/20/2015 INSTRUCTIONS Applicant: Check off the "Requested" box for each privilege requested.
More informationGary M. Annuniziata, D.O., F.A.C.P. Anh T. Duong, M.D. Jonathan C. Lin, M.D., MPH. Preparation for EGD, ERCP, Peg Placement.
Gary M. Annuniziata, D.O., F.A.C.P. Anh T. Duong, M.D. Jonathan C. Lin, M.D., MPH Phone- (760) 321-2500 Fax- (760) 321-5720 Preparation for EGD, ERCP, Peg Placement Patient Name- Procedure Date and Time-
More informationCommon types of congenital heart defects
Common types of congenital heart defects Congenital heart defects are abnormalities that develop before birth. They can occur in the heart's chambers, valves or blood vessels. A baby may be born with only
More informationWeight-Loss Surgery for Adults With Diabetes or Prediabetes Who Are at the Lower Levels of Obesity
Weight-Loss Surgery for Adults With Diabetes or Prediabetes Who Are at the Lower Levels of Obesity A Review of the Research for Adults With a BMI Between 30 and 35 Is This Information Right for Me? If
More informationRadiation Therapy for Prostate Cancer: Treatment options and future directions
Radiation Therapy for Prostate Cancer: Treatment options and future directions David Weksberg, M.D., Ph.D. PinnacleHealth Cancer Institute September 12, 2015 Radiation Therapy for Prostate Cancer: Treatment
More informationFacing Pancreatic Surgery? Learn about minimally invasive da Vinci Surgery
Facing Pancreatic Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Pancreatitis/Pancreatic Cancer The pancreas is an organ that produces enzymes and hormones to help your body digest
More informationRedo Banding After Band Erosion Advantages of the MiniMizer Extra Band Conclusion Approximately 67% of the patients suffering from erosion have sought revisional surgery. The choice of redo procedures
More informationTalent Thoracic Stent Graft with THE Xcelerant Delivery System. Expanding the Indications for TEVAR
Talent Thoracic with THE Xcelerant Delivery System Expanding the Indications for TEVAR Talent Thoracic Precise placement 1 Broad patient applicability 1 Excellent clinical outcomes 1, a + Xcelerant Delivery
More informationBariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY
Bariatric i Surgery: Optimalizing i Outcome Results Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende THE OBESE PATIENT : A CHALLENGE FOR ANAESTHESIA, Ostend,14/11/09 BARIATRIC SURGERY 50 s : First Reported
More information