If you can see the endoscopic picture, you can see here that I've retroverted my scope. I'm using an Olympus EZ 1500 scope. I'm looking at the D junction carefully and if you can see, this is probably Hill 2 now here. Hills 1 and 2 are the people who benefit by this procedure. Hills 3 is not good for this and of course, 4 is probably surgical. What's the plan here? What's the plan? Yeah. The plan now, yeah, Mohin, the plan is first, I'm sure you can see very clearly the greater curve, the lesser curve. This procedure has to be done in a horseshoe fashion on the lesser curve, leaving about one centimeter of the greater curve part intact. So, what I'm going to do is I'm going to use a Irby APC catheter to mark out that area which I'm not going to, that is I'm going to leave it alone. I'm using an Irby machine VO3. The power settings are very important for this. The power settings, if you can concentrate on the machine, show the machine. I'm using a power of 9.3 effects, 99 watts and also the flow is going to be 0.8 liters per minute. This is the thing. This is a little different from what we do a standard procedure, okay? Now, the very important thing is to create this beyond the skimmer columnar junction because if you include the skimmer columnar junction, you'll get into problem because it'll produce stenosis. So, what I'm going to first do now is I'm going to mark out the area which I'm not going to ablate. So, I'm using an Irby APC catheter, APC catheter to first mark out this area. After I do that, I'm going to raise the submucosa and then do the actual, this is the first APC mode that we're using. And you'll end up using that same catheter for ablation later. So, yeah, so ideally, you'd have hybrid catheter, you can use Pratik, but what I'm going to do is I'm going to use the injection technique because that's accessible to most people and then use this only for ablating. So, this is the area I'm going to leave intact, right? And now I'm going to go to the other side and then leave a small area here. So, I'm going to leave. Why is it so important to keep this area intact? I didn't get the question. Why is it so important to keep this area intact on the greater curvature? Yeah, because if you include this area, then the stenosis is a very high chance and these people can sometimes go into dysphagia because of the stenosis. So, you have to leave at least one centimeter of the mucosa on the greater curve intact so that the complete stenosis does not occur. That's the reason.

Olympus EZ 1500 scope

procedure

lesser curve of the stomach

Irby APC catheter

power settings and flow rate