All right, well, I'm going to go ahead and get started. So I was chair of this particular committee for over six years. They kind of kept me on, and I'm not sure exactly why, but other than to torture me with thousands of videos that came in for review. But I kind of wanted to give you an idea about some of the things that you should be thinking about when you're submitting videos for DDW. So my disclosure. So this is your goal, right? The path. So this is the ad that came out for DDW 2024, which, of course, is going to be held in Washington, D.C. First things that you need to know is that there are actually two video forums, right? So there's the video plenary, which is really what you need to aspire to. Most people think of the other video session, which is World Cup, as kind of like the premier session. But it's actually our entertainment section, so to speak. If you're submitting videos, really, you want to pick video plenary, because these are where the awards are given out. So it's the most prestigious, highest-ranked DDW videos. There are these Bob Awards. So these are awards that are given for the best of the best in each of the sections, okay? Eventually, I think, hopefully, ASGE will come to recognize Dr. Raju in this process of creating video plenaries, one of the, I think, mentors to many of us in this room with video editing. So I'm hoping, and I'll keep plugging for this until it comes to fruition, but I really think these Bob Awards, the best of the best awards, should be called the Raju Awards, because they're the highest-scoring videos in each of these categories. There is an overall winner, which is the Mel Shapiro AV award, which is the three top highest-scoring videos for DDW. And so we give these videos off to Dr. Willingham, who's currently the editor for Video GIE. He's blinded to where these are from. Hopefully, none of these are from his institution. I don't think anybody from his institution has ever won an award, but no, I'm just kidding. He picks one out of the three, which he thinks is earth-shattering and deserving of this award. So Mel Shapiro is actually a gastroenterologist in Los Angeles who actually created the very first endoscopic video series, so well-deserved named award. So ASGE World Cup, this is where it's more of a fun thing. The judges dress up in their country's costumes. The presenters of whatever country that they're representing when they're coming up to present their video are often in the dress of their particular country of origin. You can see, you might recognize some of these judges up here. Yes, well, we're getting to that. And there's Dr. Martin wearing a cowboy hat. I'm not sure how that is representative of Mayo Clinic, but anyway. He's very happily the chair of ceremonies. He's kind of like the master of ceremonies. He's kind of leading presenters onto stage, and then he's asking all of these judges to give scores. So it's more of a friendly, competitive atmosphere. And so these are videos that actually don't make it to video plenary. So that's why I keep plugging you guys to go to video plenary for your selection when you check off that box at DDW. And about eight to ten countries compete. And then at the end of the judging session, if you've ever been to World Cup, it's actually quite fun. Unfortunately, it's kind of held on the last kind of session of DDW, but it's worth attending at least once because it is quite fun, I think. And the judges are often very convivial. They'll laugh. They'll make jokes about each other's criticisms of videos. And then ultimately, the master of ceremonies then awards the trophies. And so here we have Captain Marvel, or actually Captain Endoscopy with Captain Marvel. This was one year in which the award winner actually was dressed as Captain Marvel as well. So it's a fitting costume. I believe that in the movie, both of these costumes were represented. If anyone wants to borrow that outfit, with the vinyl red boots that went with it. Yes. You can also talk to our agent about movies as well. I can't believe you don't have a picture of Klaus with the vinyl red boots. Yeah. Well, that's for next time. Did I send that to you? I hope I sent that to you. Klaus is here the next time. So things that the committee works on is trying to figure out, the judging actually takes place over three rounds. There can be up to 150 videos that are submitted for DDW, and we're trying to find the best videos to put into video plenary. That usually winds up being somewhere between 15, 18 videos, and then there are about eight to 10 videos that are put into World Cup. So you can see that there's a big funnel to where each video winds up going to. This is some of the judging criteria. So there's actually, I think, more than 60 members on the video plenary in World Cup committee. So it's a lot of people. And so they're going through these criteria, trying to score these videos. So clinical practice merit is an important characteristic. You got to have something that shows an interesting problem, a clinical case, a scenario that comes up in your practice that other people might get some educational impact on and what you did, different from what's done in the literature, or a new technique, or are we doing something beyond third space, or you're doing some experimental endoscopy procedure, some idea that comes up during the next couple of months. You should think about incorporating that. And then how well is the video constructed, right? So all those things that you heard about earlier with the video session that was led by Schaefer and Phil, they gave you some tips. Those are things that you should really consider, and how well it's made is an important thing. Practicality, is it something that can lead to a change in practice in other institutions? Is it something that's feasible, not way out of wackiness, something that no one else is going to attempt, either from ethical reasons or moral issues? The presentations really need to have some good clinical and scientific insight. The technical qualities are going to stand up to scrutiny and criticism. Is there going to be another way to skin the cat, so to speak, that would have been safer or easier to do in a patient? So Harry showed one of his videos about doing the band ligation of a neuroendocrine tumor in the rectum. Was it possible to actually just leave the band in place and not do the resection? So kind of illustrating, just because you can't doesn't mean you really should. So that's another clinical pearl that you should take as an advanced therapeutic endoscopist is that someone may ask you to do certain things, but you really need to think, is that in the best interest of the patient? And then entertainment value, does this video make you say, wow, this is great? I heard some of those comments earlier today that you did get some wow factor high in some of your productions this morning. And this is the scoring system. So the reviewers are scoring these videos anywhere between one and seven, one being the best video and seven being something that they're going to reject. And it's very rare for a video to get rejected. So the reasons for rejection are a number of things, which I'm going to go into. So these are the categories that you can submit to. So you can see that there's a wide range of categories, including endoscopic adverse events, if Dr. Faux wants to submit her particular video with better editing. So tip number one, start now, right? Today is September 23rd. Guess what? DDW's deadline for submission is November 30th. You have less, what, just a little over nine weeks or so to get something done. So work on it now. And then follow those submission guidelines to the T. There are a website, which is here, that gives you the submission guidelines. Really look at those instructions carefully and follow them to the T. If you do that, you're more than likely going to have your video accepted, whether it gets accepted to Video Plenary, World Cup, or to GI Leap is another matter. But just doing those things, you're going to have an accepted abstract. So key errors. So I wanted to point out some of the things that reviewers will come across and say, oh, it's rejected. So things like videos that are more than eight minutes, there's a good chance that your video is going to get rejected. It contains institutional names and logos, so please don't do the Mayo Clinic thing and put Mayo Clinic on every slide. And those are the kinds of things that are considered no-nos. Product names, we talked a little bit about this in the past, as well as this morning. So example was don't put Axiostem, don't put the brand name, FTRD, use the generic name. If a video contains HIPAA information, that's automatic reason for rejection. You're not going to get the opportunity to redo your video and put that white box around the patient information. So just make sure that when you review your videos, make sure that there isn't that on there. And then copyrighted images, I think we talked about. So the third thing and the last thing is test, test, test, and retest. Keep looking at your videos, making sure that the voice cadence is correct, that your video stream works well, that it flows well, that there aren't any typographical errors, that you have other people looking at it. So pay attention to the details. Production and testing takes time. You already heard that for every minute of your video is going to take about an hour's worth of back end work. Make sure things move. And then show it, I would say, to at least five people. And you can show your spouse, you can show your kid who's the expert in video games, you can show another mentor, you can show somebody in this room. We've made a network of connections with your fellow colleagues here now. Or you can send it off to Schaefer, Phil, myself, Ashley, well, maybe not Ashley. And have us look at it and get those things fixed before you submit. So I'm just going to show you a couple videos, just to give you an example of what some of the... 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 PEG-J. 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 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 10-by-15 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. Case two, endoscopic jejunal jejunostomy, 65-year-old male, was a non-surgical candidate weighing 85 kgs, with a remote history of non-Hodgkin's lymphoma and prior gastric and duodenal ulcers post-remote pill Roth II, presented with gastric outlet obstruction and TPN dependence for six months with recurrent line infections. CT scan shows a distended proximal jejunum and stomach with decompressed downstream jejunum. CT demonstrates a high-grade stricture about 50 centimeters past the gastrojejunostomy in the efferent jejunal limb. Contrast and methylene blue are injected to outline the stricture and fill the downstream bowel. A linear echoendoscope is then advanced past the gastrojejunostomy into the proximal efferent limb, which is the only site where the downstream jejunum is seen beyond the obstruction. A 19-gauge needle puncture and aspirate for methylene blue confirms the target. A 10 by 15 cotri enhanced LAMS is then advanced by direct technique into the jejunum, deployed and pulled back snug. The proximal flange is deployed under EOS guidance. Contrast injection through the lambs shows no leak and good flow of contrast into the downstream bowel. The patient tolerated a soft diet for five days but developed recurrent vomiting. Endoscopy showed an additional narrowing at the gastrogyneostomy of the biliruothrue, which was treated with an additional lambs across this GJ stricture. A repeat CT scan shows patent JJ lambs, but a markedly distended stomach with solid food. Still struggling nutritionally despite a patent stent, patient is diagnosed with gastroparesis and treated with an endoscopic jejunostomy. The main reasons for a failed gastrojejunostomy were either D3-D4 resection or infiltration by tumor. Other reasons included carcinomatosis and prior surgery trapping the jejunum in the right upper quadrant. Four duodenal jejunostomies were performed and in one patient a jejunojejunostomy was the only site available for bypass. 10 by 15 lambs were used in all cases. Technical success was achieved in all five patients. Bleeding requiring endoscopy was encountered in one patient due to severe esophagitis from ongoing gastroparesis. Two patients were unable to advance to a full diet and needed supplemental enteral feeds and TPN to maintain adequate nutrition over a median follow-up of 23 weeks. Techniques to highlight. If no window for EUS-GJ and not amenable to stenting, try for an endoscopic DJ or JJ. When advancement of the lambs is challenging, withdraw to a straight scope position, advance the lambs out of the channel and then reposition for puncture. Use EUS deployment for the proximal flange so the scope doesn't have to be pulled back, threatening mis-deployment. In conclusion, when no window for EUS-GJ or enteral stent is available, EUS-DJ or JJ may have similarly successful technical outcomes and could help avoid the need for enteral feeding tubes or surgery. Larger studies are needed to establish safety and efficacy of this approach. So you can see why this was an award winner, right? What what things did you like about this video and and what things did you not like? You can shout them out. Shyam Irani let you hire him to do your voiceover for videos because I love his vocal part. I think it was nice the way the video showed the salient features, right? I mean, you know, edited to nice parts where, you know, they already showed putting the tube down the first one so you didn't quite have to... I like that it was multimodal so you see CT images, fluoroscopy, ultrasound, endoscopy. It just keeps keeps it interesting. I also like that he kept the clinical presentation very concise. You know, it's just a couple of bullet points. This is what this patient looks looks like. It's not like they presented to the ED with a heart rate of this or that. It's really just getting to the important aspects of their clinical presentation in a few bullet points. It was a really exciting pace. It really keeps you on the edge of your seat there. It's a bit unfair because it has it carries the wisdom of an expert being the first author and the author of the video, you know, and I think that a lot of times like what to echo what Jen was saying in terms of like being able to make it concise and not include like the 65 year old man with diabetes, hypertension, hyperlipidemia, like all those aspects come with like experience, right, in terms of like being able to narrow those things down. When you're advanced fellow you're still so close to your medicine training that it's hard to shed some of these things without feeling like you've left the case presentation too naked, if you will. Also novel and new. I mean that's, yeah. And it's like it's it's a spectrum of cases which keeps you engaged. Yeah, and he also did a good job. I'm sure, you know, I would think that some of the fluoroscopic, you know, CINI is sped up a little bit, you know, where he's getting wire access and really just showing how it's supposed to be, but it's not jumpy. It's very clear. You can see what he's trying to to achieve and and also the labels that he put on top of the video to sort of say, hey this is the efferent limb, this is where we're aiming, you know, stuff like that. I thought it was very helpful. Anybody didn't like something about this video? I couldn't understand the second case all that well. I found it a little hard to follow where they are and what's proximal, what's distal. I think I get a little bit lost in the second case, but the first case was easier to understand. Yeah, especially since didn't seem like it worked so. Or was it not standable? The first one clearly looked not standable, but the second one actually. Yeah, so these were all critiques that were actually brought up during the video plenary session, so you guys are spot-on with the critiques. Nevertheless, this is what the video GIE editor picked as the best out of the three that we gave him. You know, I'm gonna encourage you, because there are other, you know, videos out there that, you know, you can look into GIE leap. This is also another wonderful one that I would recommend looking at, Andy Wang. He did, you know, a really terrific job with the fluoroscopic images and labeling, and so, you know, take a chance to look at this as well. Gives you some ideas about what you can do incorporate in your own videos. Sometimes, you know, the idea of flattery, right? It's, you know, it's copying what somebody has already done best or done well. You know, there are a lot of people that try to be Steven Spielberg, but, you know, if you can capture some of the magic that he does with his filmmaking into your own videos, just think outside the box with what people show during videos. So don't forget to, you know, be a little bit creative, but make sure that those five people that you show don't disagree with what you're trying to do. Being creative is being just disconcerting, okay? So Rhonda Foss, Vanessa Kaiser, and Ed Dellert are the main drivers behind this committee, so it's a shout-out to all of those. And when I was a previous chair, there were 61 members. I'm not sure how many there are on the current edition. John DeWitt is the current chair, but don't reach out to him. He'll refuse to answer your questions if you come up with something about your video. And then, last but not least, you know, this course was born in Cleveland, so if you ever get a chance, come to Cleveland and see the city. Thank you.

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