You see how what we are doing now, we are now putting the guide wire through this channel and then the guide wire will now come out through this channel over here. And now we start pulling the wire on this side. And as we pull the wire on this side, I'm going to slowly pass this device. Can you focus the camera down a little bit? And now can you see this how I'm passing this and you can actually move it. Give the external camera a big picture, please. Yes. See how it looks good. I'm it. So the question is, is this I'm seeing the patients not intubated and stuff. So this is under propofol is intubated patient is intubated. Okay. So I've passed this device until it comes to 55 centimeters. There are markings on this device, almost like an endoscope. And the next thing to do now is to insufflate the stomach. So I'm going to use this manometry cuff here, like a spigot manometer cuff. And then we will inflate air inside the stomach to keep the stomach inflated. Now, once the stomach is inflated, now I'm going to pass the endoscope inside. So you can see the endoscopy picture, which is inside the channel of this device. And I'm going to pass this scope inside the stomach. Now you see here that the scope has gone in the stomach. You can see that now I'm going to push the device in and gently turn the device in a U shaped completely U shaped so that it comes towards the junction. So I'm at these are full thickness placations. Huh? Yes. Full thickness placation. So the next step to do is to open the device. I'm going to open the two arms of the device. Now there are various methods of full thickness placation or remodeling of the OG junction. You can either do it on the greater curvature over here, over here, but I usually prefer to do it on the lesser curvature. So the principle is almost as if you are doing a anti-reflux mucosal resection or a ARMA procedure where you have secretarized the lesser curvature part of the LES so that the greater curvature gets pulled up like a sling. So what I'm going to do now is I'm going to rotate this device and bring it towards the lesser curvature. So see what I'm doing now. I'm rotating it. And as I'm rotating it, even Sehzad is also rotating the scope. I'm going to take the device a little bit away. Sehzad is basically an endoscopist. And position my place properly, give a little insufflation. Now, Amit, have you seen any differences in results based on the lesser curve versus the greater curve placations? Yeah, I have found lesser curve placations to be better. I need a little bit better vision with the scope and insufflation of air a little bit. Can you placate both or it causes dysphagia? No, we can placate both. But I usually prefer to placate tabular ferroscope. Now what I'm going to do, now I'm going to pass this helix a little bit over here and now rotate it. And I'm going to pull the tissue inside, fix it, now bring the device a little bit nearer, air is not insufflating. And now, once I come to a reasonably good position, I'm going to bring it to the I'm going to bring it to the close position, gently close it. OK, push it back. Wait, I'm going to release it a bit. No, release it a bit. Yeah, I'm going to take it a little bit on this side. So, Amit, as you did that nicely, as you brought it back in, is that because you thought you had too much tissue? No, I thought I was not in the right position. I need to go a little bit on that side. So I need to turn the scope also on that side. Yeah, this is a better position. Little bit near. This is a better position. See, this is the right area which I want to pull inside. So as close to the G-junction. Yeah, but we should not enter the esophagus. Yeah. Go in the stomach. So see what I've done now? Now I pulled it, fixed it. Now I'm going to rotate it a bit, bring it a little near. Over here. Amit, is this the newest version of this device? This is the latest version. Now see what I'm doing. I'm slowly closing the device and turning it so that it's like a fundoplication.

medical procedure

device treatment

guide wire

endoscope insertion

OG junction remodeling