Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-BO_Kolb_Endoscopy and Therapeutics with Surgically-Altered Anatomy

BO_Kolb_Endoscopy and Therapeutics with Surgically-Altered Anatomy

Pdf Summary

The document is a comprehensive presentation by Dr. Jennifer Kolb on endoscopy challenges and therapeutic approaches related to surgically-altered anatomy, particularly in digestive diseases. The presentation covers numerous types of surgeries like bariatric, pancreaticobiliary, colorectal, and esophago-gastric surgeries. These surgeries, such as esophagectomy, antireflux surgeries, Billroth I & II, sleeve gastrectomy, Roux-en-Y gastric bypass (RYGB), and Whipple procedures, often complicate conventional endoscopic practices due to anatomical alterations like anastomoses and the exclusion of certain limbs.<br /><br />Dr. Kolb emphasizes the common challenges posed by these surgeries, such as loss of landmarks, access difficulties, equipment limitations, and issues with scope length and angulation. She provides detailed guidance on navigating these complexities, such as reviewing operative notes and imaging, choosing the right scope and devices, and coordinating with multidisciplinary teams, including surgery, interventional radiology, urology, and ENT (ear, nose, and throat specialties).<br /><br />The document also outlines specific complications and failure modes associated with surgeries, including anastomotic leaks, strictures, reflux esophagitis, delayed gastric emptying, sleeve stenosis, and marginal ulcers. The presentation features strategies for managing these issues using various endoscopic techniques such as dilation, stenting, Transoral Outlet Reduction (TORe), and Edge techniques for complex ERCPs in altered anatomies.<br /><br />Dr. Kolb advocates innovative solutions such as AI navigation, personalized planning, 3D reconstructions, and robotic-assisted endoscopy as the potential future advancements in this domain. The presentation concludes by acknowledging the collaborative effort of her colleagues who contributed cases and videos, illustrating a multifaceted approach to tackling endoscopic challenges in surgically-altered anatomies.

Keywords

endoscopy challenges

surgically-altered anatomy

digestive diseases

bariatric surgery

pancreaticobiliary surgery

anastomotic leaks

endoscopic techniques

AI navigation

robotic-assisted endoscopy

multidisciplinary teams