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 presents innovative uses for conventional endoscopic devices to enhance procedures. His presentation focuses on ten key methods, each maximizing the potential of existing tools to improve patient outcomes.<br /><br />1. **Augmenting Suction**: By applying Poiseuille’s Law, increasing the suction radius and reducing the length when bypassing the umbilicus can double the flow during endoscopic procedures. For instance, bypassing the umbilicus and connecting suction directly to the biopsy port halves the length (L) and increases flow.<br /><br />2. **Clear Cap**: Utilizing a transparent distal attachment, the Clear Cap can tamponade bleeding, isolate the visual field, and assist in manipulating food boluses, which allows a clearer view and improved functionality during Endoscopic Gastro-Duodenoscopy (EGD).<br /><br />3. **Hemostatic Forceps**: Effective in post-polypectomy arterial bleeding and managing Dieulafoy’s lesions, hemostatic forceps offer a combination of mechanical and thermal hemostasis. This method is cost-effective and enhances procedure success.<br /><br />4. **Endoscopic Vacuum Therapy (EVT)**: Involving a sponge and nasogastric tube, EVT promotes healing by enhancing perfusion and controlling exudate. It’s particularly effective for esophageal leaks, though labor-intensive.<br /><br />5. **Percutaneous Suture Closure**: This involves using Spybite forceps to insert and secure sutures intralumenally via a needle, useful in closing fistulas.<br /><br />6. **Rotating Clips**: These are useful for the removal of X-tacks and for securely dragging intralumenal tubes via the "alligator roll” suture loop technique.<br /><br />7. **Through-the-Scope (TTS) Fully Covered Metal Stents (FCSEMS)**: These stents, deployable without fluoroscopy, offer superior control of esophageal variceal bleeding compared to traditional balloon tamponade methods.<br /><br />8. **Band Ligation**: Effective for both diverticular bleeding and gastric antral vascular ectasia (GAVE). Studies show superior outcomes compared to clipping, with fewer complications.<br /><br />9. **Hemospray Modifications**: Enhanced delivery methods for hemostatic powders involve bonewax—tipped catheters and CO2 borrowing from the scope, circumventing common issues like catheter clogging.<br /><br />10. **Spray Coagulation**: "APC without APC," this technique uses high voltage noncontact coagulation for large tissue areas, achieving a similar effect to Argon Plasma Coagulation (APC) without needing argon gas.<br /><br />These methods highlight inventive applications that leverage familiar tools in novel ways, optimizing endoscopic intervention and improving therapeutic outcomes.

Keywords

Dr. Andy Tau

Austin Gastroenterology

endoscopic devices

patient outcomes

Poiseuille's Law

Clear Cap

hemostatic forceps

Endoscopic Vacuum Therapy

suture closure

metal stents