Now, to explain why Phil didn't get on the plenary, I was going to ask Dr. Eisenberg to explain that, because he chairs the committee that reviews these videos, and Gerard's one of my partners, a long-time colleague, he's chaired this committee that I used to be on. It is a lot of work over the Christmas holidays, but it's also fun work reviewing these videos, and a very important committee, because one of the challenges, both with videos and live courses, they can be very educational, but you don't want it to be just a show. And it's just a show that people start doing things that actually harm patients, and the committee has to decide what is educational, what's worth putting on the plenary, and what is not, and he'll talk about the questions that go through people's mind when reviewing these videos. Gerard. Thanks, Amitabh, and thanks, Praveen, and thanks to the ASG for putting this together. I think this is a very valuable experience for everyone, including us as faculty members, because it gives us a chance to meet the people who are going to change the future of endoscopy. I remember participating in this the very first year, and several of the people here on the left side were former members or former students of this particular course. So you can see that just by sitting here on the right side that your trajectory can allow you to be here on my left side. So to comment on Amitabh's question about Philip, so Philip did show that he did get two Oscars. So he did get two Oscars on the video plenary. I can't comment on what happened afterwards. Maybe he just hit his summit of Emmy excellence or Oscar excellence and has dropped off, or he's just got too much Philip G. Hans videos with his particular stuff. But I think you are the only one that has actually won two Oscars in the same meeting. So that's actually tremendous. So I've been on the chair for this committee for a while. I don't know why the ASGE thought that I deserved to keep going with being chair. They finally realized that I needed to rotate off. And so now I am the immediate past chair for this. So I've been on this committee first with Raju when Raju was chair of this committee and he had enough confidence in me to take over his position almost seven, eight years ago. And so I'll give you some of my tips about what makes it to video plenary and what makes it to World Cup. I think that if you take both Philip's and Schaefer's comments about how to make a great video, I think it's almost a guarantee that you're going to get into video plenary and or World Cup by using what they've suggested. So I really highly recommend that you use their information to create those videos to make it Oscar worthy or as the ASGE calls it, Bob worthy. Bob is the best of the best awards that are given out at video plenary. So no disclosures. So here's where it really starts. So when you're thinking of creating videos, you really need to start now. DDW, of course, will be here next year. You're really trying to shoot for video plenary. Video plenary is actually contrary to what some people think is actually where the best videos are presented. It's not World Cup. World Cup is more of a fun, competitive atmosphere. It's not where the highest ranking videos are chosen. These are videos that don't quite make it to video plenary, but are worthwhile in terms of the wow factor. And it just gives people an entertaining forum to participate. But if you really want to get recognition for the work that you're doing, you really need to aim for video plenary. So the Bob Awards, as I said, it's the best of the best awards. I am hoping at some point in the future, if ASGE is willing, we will call these the Raju Awards. These are the highest scoring videos in each category, and there are a number of categories that I'll go over with you. And then there's the ASGE Video GIE Award, which is actually the highest scoring video for video plenary. And so this is a combined award with the ASGE and Video GIE. This particular award, so what we do as part of this committee is once we've decided, it actually goes through several rounds of peer review. We can get anywhere between 150 to 200 videos in a year. There's about 60 members of this committee that review these videos. And you can imagine that this is a tremendous amount of work. Obviously, this is taking place over the holidays. We've actually tried to move some of the work outside of some of the holidays at the end of the year. But it is a huge amount of work and trying to decide which ones move forward. There's an elaborate scoring system, which I'm going to go over with. So you'll get an idea about how we judge videos. But eventually, the three highest scoring videos are given to the editor of Video GIE, and they're blinded to the scores that the committee had decided. And he kind of makes the he or she kind of makes the final decision for who wins this award. So World Cup, obviously, this is this is a really fun atmosphere. This this idea actually originated with Amitabh many years ago. World Cup, of course, is taken from the soccer world or football world, depending on where you're from. I prefer football, but soccer in the United States. And so this is just a really fun atmosphere. This usually takes place on a Tuesday afternoon of DDW. This is where you get kind of get tired of all the scientific sessions that you've gone through, all the posters that you've gone through. You kind of get your brain gets filled up with all the facts and figures, all the learning that you've had. And this kind of just makes it a really fun experience to go to. Just let your brain rest and and watch the fun. So it's one of the more popular sessions at DDW. So usually about eight to 10 countries participate, and so you'll see that these are the judges. There'll be a number of judges. And so the competition is that each of the judges will score the video that each country is representing. And you'll see these rankings show up real time during the competition. And then there's obviously a gold, silver and bronze trophy awarded to the top three videos in World Cup. This is one of our emcees, Dr. Faux, who's laughing there in the background. And it turned out as she's wearing this costume that I think everybody recognizes, the actual top award winner, I think she was from the United States, I'm pretty sure, also was wearing a very similar costume. So this was my picture to illustrate how fun and engaged that people can get with this. She looks good, doesn't she? All right, so key criteria. This is what we look for when we're meeting, looking at videos. Is there a clinical practice merit? Is it showing us something new or improved? If you're showing a video on lumen metal stents, lumen opposing metal stents, you're just not going to get that particular video in because it's been done already. But if you're using it in a new technique or a new way, there is certainly a possibility that your video could get in. Use Schaefer and Phillips ideas about making sure that it's well organized, easy to follow, understand, and really do need to follow the submission criteria. So, you know, if you're going to get anything out of me, just follow the instructions closely, OK? If you follow the instructions closely, you've had 90 percent of success rate already. Practicality, is that something that is logical, feasible, easy to incorporate into clinical practice? Those are the things that we kind of look at. We don't want something that a particular IRB at another institution would say this is something that is way off the reservation. And probably shouldn't be done because of the safety risks associated with that. So just keep that in mind. Presentations, again, is it clear, brief? Does it really provide a good understanding and clinical insight of what's going on with the particular patient or a particular technique that you're describing? Technical matter, is it going to stand up to scrutiny? So, you know, you've got to make sure that this is something that you might be reproducible in somebody else's hands. Can this be taught to somebody else and somebody else can actually achieve the results that you get, the outcomes that you have? And, you know, the last thing that we kind of look at is, does this, you know, really make us say, wow? Those are the videos that really are going to push us to getting, if you have all this other criteria, that's kind of the stuff that's going to get you into video plenary. All right, so scoring, these are the things that our scores are. It's a little bit reversed from, you know, a brain standpoint. We usually think higher scores give you a higher chance of getting into video plenary. But here in our instances, it's a lower score. So each committee member is giving a score, a peer review score for these videos. And if you can think about it, having 60 people put in their information about what they think is good or not good. And you have to collate all of those comments that each of the committee members is putting in. It becomes a extremely large spreadsheet. And so Raju probably remembers the day of trying to herd cats of committee members and trying to come to a consensus with some of these videos. So these are the categories. And the categories have expanded over time. So the newer ones are endoscopic adverse events, artificial intelligence, and educational endoscopy. The, you know, you'll see sometimes it might be a little bit challenging to figure out which category a particular video goes into. I would say that at this point, ERCP and EOS are probably one of the more popular categories to submit to. So if you have something that is EOS guided and is associated with, say, notes and or there's an endoscopic adverse event associated with the EOS event, tend to submit to a category that may not, you know, that may correlate with the other version of other than EOS or ERCP. I'm not saying that you shouldn't submit to EOS or ERCP if it is purely EOS or ERCP based. But I think that if you're trying to get something, you'll have less competition when you go into those other categories. Small bowel, believe it or not, tends to have one of the lower rates of submission. I'm a small bowel endoscopist and I'm always surprised by this. But educational endoscopy is one of the newer ones that was introduced for last year for DDW. So this is a category where, you know, you want to demonstrate a particular technique and, you know, you're trying to give some educational information about how to do or perform something. And so this is something that, you know, even, you know, general fellows, first year fellows, second year fellows, third year fellows can do. Advanced fellows, if you want to push this off to your younger colleagues, this would be a great category to submit to. And artificial intelligence is actually up and coming, as most of you are already aware. And so I suspect that this category is actually going to get a lot more submissions over the next couple of years. So, tips. One, start now. Okay, you're already doing that with attending this course and doing some of the work with Raju, Schaefer, and Philip. We'll guide you through a lot of the intricacies of developing these videos. The DDW dates for submission have not been released yet. I suspect that, based on prior history, it's probably going to be that 1st of December date. That's typically what it's been in the past. So, you have a couple months, but don't wait until December 1st to submit. As Philip said, you know, there's a lot of bandwidth going into the site, so try to submit either the day before or the week before. Follow the guidelines to the T, okay? That's my second tip. And it's probably even more important that, you know, you really look at what these guidelines are, because if you don't follow the guidelines, even if you have a great video and you have something like, you know, there's an institutional logo somewhere in the video, it's not going on your video and you didn't realize it, there is a possibility you could get rejected. And that's not a fun thing to be told that, you know, you had this great video, but you missed that one thing. So, really read the instructions. They're on the website. So, errors that the committee has noted. The video is more than 8 minutes, all right? Can't do that. Institutional names and logos, contains product names or drug names. So, I mentioned luminoposing metal stents, use that. Don't use a brand name. Don't say Axios. I know that sometimes it's difficult when you're doing some of these procedures and some of the product logos tend to show up on the product itself as you're demonstrating that. Sometimes you can blur the image a little bit, but I don't think that the committee is going to nix your video. For example, if you have an Herbie catheter, as most of you know, the Herbie name shows up on the tip of the catheter. And as you're using it to do APC, it's very challenging to not have that up there. That's probably why companies do that, so that they can get easy brand name awareness for free. But just try to avoid those things. Try to use the generic names, all right? And any video that's going to contain any kind of HIPAA information is automatic rejection. So, if you have to look carefully on your fluoroscopic images, it has a patient name or a number. There's even a hint of a medical record number on it. It'll get rejected, all right? So, be careful of using copyrighted images. So, this has been an area of enforcement for DDW, so that if you use a copyright image during your presentation, you are liable for a legal standpoint of potentially getting sued by whoever owns that copyright image for using it for purposes other than what they have expressly warranted. So, be careful and make sure that if you're going to use something to get permission from the copyright owner, and make sure that's explicit, okay? All right. So, the third thing, well, Schaefer and both have said this over and over again, test, test, test, and retest. Make sure that you're paying attention to the details. Obviously, all the stuff that they just showed you in less than 15 minutes takes much longer. You know, I'm not going to say that I can produce a video in an hour. It usually takes me several weeks to get a video. I don't know what Schaefer probably can do it in a day. Make sure your video narration and your inserted video clips and images flow smoothly. You don't want that herky-jerky video presentation. And you really want to make sure that you show it to at least five different people, okay? Even somebody who may not be in the medical field will pick up on something that you have in your video that a medical person would kind of gloss over because they're just so used to it. But, you know, pick a family member who's not in medicine to look at it. They're not going to understand anything you're talking about, but they might say, but they might say, hey, did you notice that there was a flashing strobe light in the back while you were doing, you know, your video or a particular case? And so they may point out things that you may not realize. And use your resources. You use your newly found friends here next to you, okay? Um, so I'm just going to show you, um, just for the purposes of time, uh, just, just one of these videos. And what I want you to do, I'm not going to, you know, I don't want you to pay attention to, you know, the technique, procedure. I want you to pay attention to how they constructed this video. And so every one of you, I want you to think about what made this video good and what could have they done to make it better, okay? Gastric Outlet Obstruction. When you can't do an endoscopic GJ or enteral stent, try an endoscopic DJ or JJ. Gastric outlet obstruction can be managed endoscopically with luminal stents or EUS-GJ. However, some situations can preclude both. A very long, sharply angulated stricture, not amenable to stent, with intervening colon, distance of the bowel from the gastric wall being more than a centimeter, adhesion strapping the jejunum, and some cases of post-gastric surgery. In these situations, we have two options, surgical bypass or enteral nutrition beyond the point of obstruction. We present a third option, a duodenal jejunostomy or jejunal jejunostomy, and review results in five patients. Endoscopic DJ, case one, a 63-year-old female weighing 41 kilograms with recurrent metastatic pancreatic cancer after subtotal pancreatic splenectomy and partial duodenal resection, presented with gastric outlet obstruction for three months and refused a PEGJ. CT shows severe gastric outlet obstruction at the level of the prior duodenal resection. The duodenal bulb is dilated, and then we reach a point of obstruction in the area of the third portion of the duodenum. An ERCP balloon is used to inject contrast to demonstrate a very long jejunal stricture, not amenable to duodenal stenting. A 0.025-inch guide wire is then passed through the stricture into the proximal jejunum, followed by the balloon. Lots of contrast is injected here to make sure there is no further obstruction downstream to this stricture. The guide wire is left in place, and the balloon is exchanged. A nasobiliary drain is passed over the guide wire across the stricture to allow infusion of saline to distend the jejunum. The scope has to be shortened to advance it across the stricture. The scope is withdrawn, and the nasobiliary drain is left in place. The scope is withdrawn, and the nasobiliary drain is left in place beyond the jejunal obstruction to fill the small bowel with some contrast and methylene blue as needed. Several attempts are made to look for a site for a gastrojejunostomy. However, the only loops of bowel seen are too far away with too much intervening tissue. The jejunum seen in this view is not dilated and corresponds to the area of the jejunal stricture. This is not an appropriate target. So the scope is advanced to the second portion of the duodenum to see if we can find the downstream jejunum, and slowly the jejunum can be brought into view by pushing into a long scope position. The scope has to be pulled back into the stomach to allow a 19-gauge needle to come out of the channel. Then the scope is re-advanced to a long position to aspirate methylene blue to confirm we're in jejunum. The same maneuver has to be performed with the 10x15 cotri-enhanced lambs to allow it to come out of the scope channel. It is then advanced into the jejunum using direct puncture technique without a guide wire. The jejunal flange is deployed and pulled back snug. A guide wire is advanced into the jejunum now given the unstable scope position in case access is lost. Maintaining scope position, the duodenal flange is then deployed under EOS guidance and is then pushed out of the scope channel. A 15-millimeter balloon dilation is performed. An upper GI series the following day shows rapid drainage through the DJ. She tolerated a regular diet by day number two, gained 15 kgs, and lived for 18 weeks without the need for internal nutrition. So what do you guys think they did well? What could they have done better with this video? You can shout it out. Easy to follow. Yeah. I saw some abbreviations that could have been expanded on. Yeah, so they took some time putting side-by-side videos, fluoroscopic, endoscopic, EOS, fluoroscopic, EOS, endoscopic. What did you like, Schaefer? I like that they scrolled through the CT. I just think that gives you a good visual context. And this particular narrator, I've listened to some of his other content. I love the narration style. I just think he's very clear and concise. Yes. Anything that you would have said could have been done better with it? I think with the video, they could have, you know, it'd be ideal if they could get rid of all those numbers and stuff on the screen. I find it kind of distracting. And like Dr. Shaik said, I think that saying lambs from the first time that you're using it, you need to expand that out for somebody that may not know what it means. Guys, there's microphones in front of you. Use them so everyone can hear. Well, I mean, I'm going to stop here because I think we're kind of getting a little bit over time. But I think that, you know, when you look at these particular videos, and these are available on GI Leap, so, you know, use these as kind of a guide or as your North Star as to what videos are extremely well done and well produced. If you look at some of these, you'll get some ideas about how to pair some of the endoscopic, fluoroscopic, EOS, anything that you're using from a visual standpoint. You'll get some neat tricks about how to do the fade. So the more high quality videos that you look at, the more ideas that you can actually incorporate into your own production. So I do want to thank several people in the ASGE. They're not here, I don't believe. But Rhonda Foss, Vanessa Kaiser, and Ed Dellert, along with the huge number of members. I think this is the largest committee that the ASGE has. It's a huge endeavor. And so hopefully one day, for those of you that haven't made it to Cleveland, hopefully you'll be able to make it to Cleveland. Thank you so much. I think we have time for questions, right?

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