4%). Abdominal pain was relieved immediately and liquid diet was resumed after the procedure. Rebound tenderness and guarding at McBurney’s point disappeared BTK inhibitor in vivo within 12 hours in 27/29 patients without periappendiceal abscess, 9 patients took ERAT in outpatient clinic without admission, no procedure-related complications occurred in any patients, 2 (6.9%) patients recurred during 1 to 36 months of follow-up and surgical intervention
was required. ERAT appear to be a safe, effective and minimally invasive diagnosis and treatment modality for patients with suspected acute appendicitis. Figure options Download full-size image Download high-quality image (484 K) Download as PowerPoint slide “
“Endoscopic submucosal dissection (ESD) and Per Oral Endoscopic Myotomy (POEM) procedures are elegant endoscopic techniques to explore the submucosal space and to offer minimally invasive approach to treat diseases that otherwise require invasive surgery. We envisioned using the submucosal space to access pylorus and to perform pyloro-myotomy. To our knowledge this has not been reported before. Potential applications of this technique could be in the endoscopic treatment of gastroparesis, pylorospasm, direct visualization injections to pylorus and
other GI muscles and even in full thickness Bortezomib resection of gastric sub-epithelial neoplasms. To report feasibility of endoscopic per oral pyloro-myotomy in a live intubated porcine model. Methods. Study
was approved by our animal lab facility. Two endoscopists with ESD experience performed the procedures. After adequate sedation, EGD (GIF 160, Olympus) was performed with a transparent cap attached. Pylorus was traversed a few times and ease of scope passage was rated on a scale of 1-5 (1= widely patent- easy passage; 5=spastic pylorus – moderate resistance). After an learn more adequate lift was obtained with a saline-methylene blue solution injection, a horizontal mucosal incision was made with Hybrid I knife (ERBE USA Inc., Marietta, GA), 10 cms proximal to the pylorus (Endocut Q, 30W,E2). Next the submucosal space was entered and tunneling was performed by submucosal dissection (dry cut -50W,E2), till pylorus was traversed and an open submucosal duodenal space was reached. Bleeding was controlled with soft coag (80W,E5). For myotomy, TT knife (Olympus Inc., Center Valley, PA) was used (spray coag 50W,E2) to hook & divide the inner transverse & oblique fibers, leaving intact the outer longitudinal fibers. Myotomy was started 5 cms proximal to pylorus and continued till pylorus was divided. Scope was withdrawn from submucosal tunnel and ease of scope passage was recorded again. Animals were euthanized and necropsy was performed. Procedure duration, mucosal injury, muscularis propria (MP) injury and perforation rates were recorded. Between July- November 2012, 5 POP procedures were performed.