ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-18_TAU Hot Videos

18_TAU Hot Videos - Old Tools in New Ways

Pdf Summary

Dr. Andy Tau from Austin Gastroenterology shared innovative methods of using existing medical devices to tackle various challenges in gastroenterology. Key points include:<br /><br />1. **Augmenting Suction:**<br />   - Utilizing Poiseuille’s Law, suction efficacy can be increased by reducing the length and increasing the radius of the suction pathway. This can be achieved by bypassing the umbilicus and connecting suction directly to the biopsy port, effectively doubling the flow.<br /><br />2. **The Clear Cap:**<br />   - It is a versatile tool useful for tamponading bleeders and removing food boluses. Clear caps enable better visualization and effective stabilization, using techniques like water immersion for optimal hemostasis.<br /><br />3. **Hemostatic Forceps:**<br />   - These forceps are vital for managing post-polypectomy arterial bleeding and treating Dieulafoy’s lesion by combining mechanical and thermal hemostasis. They have proven superior to clips in initial hemostasis success and reducing recurrent bleeding.<br /><br />4. **Endoscopic Vacuum Therapy (EVT):**<br />   - For fistula closures, EVT involves placing a sponge connected to a nasogastric tube into the defect cavity, promoting healing. EVT has shown superior efficacy in esophageal leak closures compared to Self-Expanding Metal Stents (SEMS).<br /><br />5. **Percutaneous Suture Closure of Fistula:**<br />   - Using Spybite forceps to grab and secure sutures intralumenally with a needle.<br /><br />6. **Rotating Clip:**<br />   - Effective for removing devices like X-tacks and for securely dragging intralumenal tubes.<br /><br />7. **Fully Covered Self-Expanding Metal Stents (FCSEMS):**<br />   - Preferred over Blakemore tubes for managing refractory esophageal variceal bleeding. They can be deployed bedside without fluoroscopy.<br /><br />8. **Band Ligation for Diverticular Bleeding and GAVE:**<br />   - Proven more effective and safer than clipping, band ligation helps in stopping diverticular bleeding and managing Gastric Antral Vascular Ectasia (GAVE).<br /><br />9. **Hemospray Enhancements:**<br />   - Utilizing bonewax and CO2 borrowing techniques from the scope to prevent clogging and optimize hemostatic powder delivery.<br /><br />10. **Spray Coagulation:**<br />    - Alternative to Argon Plasma Coagulation (APC), using high voltage through a snare tip for non-contact, superficial tissue coagulation, minimizing the risk of deep tissue injury.<br /><br />These innovations highlight cost-effective and efficient approaches to enhance patient care in gastroenterology.

Keywords

Gastroenterology

Dr. Andy Tau

Suction Augmentation

Clear Cap

Hemostatic Forceps

Endoscopic Vacuum Therapy

Percutaneous Suture Closure

Rotating Clip

Self-Expanding Metal Stents

Band Ligation