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3. ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection

Author

Harry R. Aslanian, MD, FASGE, Amrita Sethi, MD, FASGE, Manoop S. Bhutani, MD, FASGE, Adam J. Goodman, MD, FASGE, Kumar Krishnan, MD, David R. Lichtenstein, MD, FASGE, Joshua Melson, MD, FASGE, Udayakumar Navaneethan, MD, Rahul Pannala, MD, MPH, FASGE, Mansour A. Parsi, MD, MPH, FASGE, Allison R. Schulman, MD, MPH, Shelby A. Sullivan, MD, Nirav Thosani, MD, Guru Trikudanathan, MBBS, MD, Arvind J. Trindade, MD, Rabindra R. Watson, MD, and John T. Maple, DO, FASGE

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as “exposed” and “nonexposed.” In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.

Published
2019
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4. Biliary and pancreatic lithotripsy devices

Author

Watson, Rabindra R., Parsi, Mansour A., Aslanian, Harry R., Goodman, Adam J., Lichtenstein, David R., Melson, Joshua, Navaneethan, Udayakumar, Pannala, Rahul, Sethi, Amrita, Sullivan, Shelby A., Thosani, Nirav C., Trikudanathan, Guru, Trindade, Arvind J., and Maple, John T.

Published
2018
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5. Biliary and pancreatic lithotripsy devices

Author

Rabindra R. Watson, MD, Mansour A. Parsi, MD, MPH, FASGE, Harry R. Aslanian, MD, FASGE, Adam J. Goodman, MD, FASGE, David R. Lichtenstein, MD, FASGE, Joshua Melson, MD, FASGE, Udayakumar Navaneethan, MD, Rahul Pannala, MD, MPH, FASGE, Amrita Sethi, MD, FASGE, Shelby A. Sullivan, MD, Nirav C. Thosani, MD, Guru Trikudanathan, MD, Arvind J. Trindade, MD, and John T. Maple, DO, FASGE, Chair

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and Aims: Lithotripsy is a procedure for fragmentation or destruction of stones to facilitate their removal or passage from the biliary or pancreatic ducts. Although most stones may be removed endoscopically using conventional techniques such as endoscopic sphincterotomy in combination with balloon or basket extraction, lithotripsy may be required for clearance of large, impacted, or irregularly shaped stones. Several modalities have been described, including intracorporeal techniques such as mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), and laser lithotripsy, as well as extracorporeal shock-wave lithotripsy (ESWL). Methods: In this document, we review devices and methods for biliary and pancreatic lithotripsy and the evidence regarding efficacy, safety, and financial considerations. Results: Although many difficult stones can be safely removed using ML, endoscopic papillary balloon dilation (EPBD) has emerged as an alternative that may lessen the need for ML and also reduce the rate of adverse events. EHL and laser lithotripsy are effective at ductal clearance when conventional techniques are unsuccessful, although they usually require direct visualization of the stone by the use of cholangiopancreatoscopy and are often limited to referral centers. ESWL is effective but often requires coordination with urologists and the placement of stents or drains with subsequent procedures for extracting stone fragments and, thus, may be associated with increased costs. Conclusions: Several lithotripsy techniques have been described that vary with respect to ease of use, generalizability, and cost. Overall, lithotripsy is a safe and effective treatment for difficult biliary and pancreatic duct stones.

Published
2018
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8. Radiofrequency ablation devices

Author

Navaneethan, Udayakumar, Thosani, Nirav, Goodman, Adam, Manfredi, Michael, Pannala, Rahul, Parsi, Mansour A., Smith, Zachary L., Sullivan, Shelby A., Banerjee, Subhas, and Maple, John T.

Published
2017
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10. Devices for use with EUS

Author

Hwang, Joo Ha, Aslanian, Harry R., Thosani, Nirav, Goodman, Adam, Manfredi, Michael, Navaneethan, Udayakumar, Pannala, Rahul, Parsi, Mansour A., Smith, Zachary L., Sullivan, Shelby A., Banerjee, Subhas, and Maple, John T.

Published
2017
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11. Radiofrequency ablation devices

Author

Udayakumar Navaneethan, MD, Nirav Thosani, MD, Adam Goodman, MD, FASGE, Michael Manfredi, MD, Rahul Pannala, MD, MPH, Mansour A. Parsi, MD, FASGE, Zachary L. Smith, DO, Shelby A. Sullivan, MD, Subhas Banerjee, MD, FASGE, and John T. Maple, DO, FASGE

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Published
2017
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12. Cryotherapy in gastrointestinal endoscopy

Author

Mansour A. Parsi, MD, MPH, FASGE, Arvind J. Trindade, MD, Manoop S. Bhutani, MD, FASGE, Joshua Melson, MD, Udayakumar Navaneethan, MD, Nirav Thosani, MD, Guru Trikudanathan, MBBS, MD, Rabindra R. Watson, MD, and John T. Maple, DO, FASGE

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Published
2017
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13. Devices for use with EUS

Author

Joo Ha Hwang, MD, PhD, FASGE, Harry R. Aslanian, MD, FASGE, Nirav Thosani, MD, Adam Goodman, MD, FASGE, Michael Manfredi, MD, Udayakumar Navaneethan, MD, Rahul Pannala, MD, MPH, Mansour A. Parsi, MD, FASGE, Zachary L. Smith, DO, Shelby A. Sullivan, MD, Subhas Banerjee, MD, FASGE, and John T. Maple, DO, FASGE

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Published
2017
Full Text
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16. ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection

Author

Nirav Thosani, Allison R. Schulman, Amrita Sethi, Kumar Krishnan, Udayakumar Navaneethan, Arvind J. Trindade, Adam J. Goodman, Shelby Sullivan, Joshua Melson, Mansour A. Parsi, Guru Trikudanathan, Manoop S. Bhutani, John T. Maple, Harry R. Aslanian, Rabindra R. Watson, David R. Lichtenstein, and Rahul Pannala

Subjects
medicine.medical_specialty, GIST, GI stromal tumor, PTFE, polytetrafluoroethylene, Resection, OTSC, over-the-scope clip, Technology Status Evaluation Report, STER, submucosal tunnel endoscopic resection, NOTES, natural orifice transluminal endoscopic surgery, medicine, EFTR, endoscopic full-thickness resection, TTS, through-the-scope, Radiology, Nuclear Medicine and imaging, Endoscopic resection, Full thickness resection, SET, subepithelial tumor, GiST, business.industry, Gastroenterology, Over the scope clip, Guideline, Endoscopic submucosal dissection, Surgery, POEM, per-oral endoscopic myotomy, ESD, endoscopic submucosal dissection, business, Significant fibrosis
Abstract

With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as "exposed" and "nonexposed." In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.

Published
2019
Full Text
View/download PDF

18. Biliary and pancreatic lithotripsy devices

Author

Nirav Thosani, Mansour A. Parsi, Harry R. Aslanian, Amrita Sethi, Adam J. Goodman, Rahul Pannala, Guru Trikudanathan, Arvind J. Trindade, Rabindra R. Watson, John T. Maple, Udayakumar Navaneethan, Joshua Melson, Shelby Sullivan, and David R. Lichtenstein

Subjects
medicine.medical_specialty, FDA, U.S. Food and Drug Administration, medicine.medical_treatment, ML, mechanical lithotripsy, Lithotripsy, Balloon, Extracorporeal, C-APCS, Comprehensive Ambulatory Payment Classification, 03 medical and health sciences, 0302 clinical medicine, Technology Status Evaluation Report, ES, endoscopic sphincterotomy, HCPCS, Healthcare Common Procedure Coding System, YAG, yttrium aluminum garnet, EHL, electrohydraulic lithotripsy, medicine, Radiology, Nuclear Medicine and imaging, RCT, randomized controlled trial, CPT, Current Procedural Terminology (https://www.asge.org/docs/default-source/education/Technology_Reviews/doc-enteral-nutrition-access-devices.pdf?sfvrsn=4), EPBD, endoscopic papillary balloon dilation, Pancreatic duct, Endoscopic retrograde cholangiopancreatography, medicine.diagnostic_test, business.industry, Gastroenterology, MAUDE, Manufacturer and User Facility Device Experience, Extracorporeal shock wave lithotripsy, Laser lithotripsy, Surgery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, FREDDY, frequency-doubled, double-pulse neodymium, Balloon dilation, 030211 gastroenterology & hepatology, CMS, Centers for Medicare and Medicaid Services, ASGE, American Society for Gastrointestinal Endoscopy, business, ERCP, endoscopic retrograde cholangiopancreatography, ESWL, extracorporeal shock wave lithotripsy
Abstract

Background and Aims Lithotripsy is a procedure for fragmentation or destruction of stones to facilitate their removal or passage from the biliary or pancreatic ducts. Although most stones may be removed endoscopically using conventional techniques such as endoscopic sphincterotomy in combination with balloon or basket extraction, lithotripsy may be required for clearance of large, impacted, or irregularly shaped stones. Several modalities have been described, including intracorporeal techniques such as mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), and laser lithotripsy, as well as extracorporeal shock-wave lithotripsy (ESWL). Methods In this document, we review devices and methods for biliary and pancreatic lithotripsy and the evidence regarding efficacy, safety, and financial considerations. Results Although many difficult stones can be safely removed using ML, endoscopic papillary balloon dilation (EPBD) has emerged as an alternative that may lessen the need for ML and also reduce the rate of adverse events. EHL and laser lithotripsy are effective at ductal clearance when conventional techniques are unsuccessful, although they usually require direct visualization of the stone by the use of cholangiopancreatoscopy and are often limited to referral centers. ESWL is effective but often requires coordination with urologists and the placement of stents or drains with subsequent procedures for extracting stone fragments and, thus, may be associated with increased costs. Conclusions Several lithotripsy techniques have been described that vary with respect to ease of use, generalizability, and cost. Overall, lithotripsy is a safe and effective treatment for difficult biliary and pancreatic duct stones.

Published
2018
Full Text
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19. Management of choledocholithiasis by direct cholangioscopy via freehand intubation using the 'J' maneuver

Author

Nirav Thosani, Hao Chi Zhang, and Bhavtosh Dedania

Subjects
medicine.medical_specialty, Common bile duct, business.industry, medicine.medical_treatment, Gastroenterology, LHD, left hepatic duct, CBD, common bile duct, Surgery, Electrohydraulic lithotripsy, CHD, common hepatic duct, medicine.anatomical_structure, Common hepatic duct, EHL, electrohydraulic lithotripsy, Medicine, Intubation, Radiology, Nuclear Medicine and imaging, Video Case Report, business, Left Hepatic Duct
Published
2019
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22. Radiofrequency ablation devices

Author

Nirav Thosani, Subhas Banerjee, Udayakumar Navaneethan, Rahul Pannala, Zachary L. Smith, Mansour A. Parsi, Adam Goodman, Michael A. Manfredi, John T. Maple, and Shelby Sullivan

Subjects
medicine.medical_specialty, CCA, cholangiocarcinoma, Radiofrequency ablation, NET, neuroendocrine tumors, RP, radiation proctopathy, Argon plasma coagulation, CPT, current procedural technology, Neuroendocrine tumors, Gastroenterology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Technology Status Evaluation Report, Refractory, law, Internal medicine, medicine, BE, Barrett's esophagus, LGD, low-grade dysplasia, Radiology, Nuclear Medicine and imaging, RF, radiofrequency, Esophageal Squamous Dysplasia, HGD, high-grade dyplasia, IMC, intramucosal carcinoma, CE-D, complete eradication of dysplasia, RFA, radiofrequency ablation, Gastrointestinal endoscopy, APC, argon plasma coagulation, business.industry, Gastric antral vascular ectasia, medicine.disease, GAVE, gastric antral vascular ectasia, CI, confidence interval, surgical procedures, operative, CE-IM, complete eradication of intestinal metaplasia, PDT, photodynamic therapy, 030220 oncology & carcinogenesis, Barrett's esophagus, ESD, endoscopic submucosal dissection, 030211 gastroenterology & hepatology, Radiology, ASGE, American Society for Gastrointestinal Endoscopy, business, therapeutics
Abstract

The use of RFA as a treatment modality in gastrointestinal endoscopy is expanding. RFA is frequently used in combination with focal EMR for the treatment of dysplastic BE and as standalone therapy for flat BE. Its efficacy in the treatment of esophageal squamous dysplasia appears promising. RFA appears to be successful and safe in the management of refractory GAVE and RP, and it may also be beneficial in treatment-naive patients. Biliary RFA and EUS-RFA are emerging technologies.

Published
2017
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23. Cryotherapy in gastrointestinal endoscopy

Author

Udayakumar Navaneethan, John T. Maple, Nirav Thosani, Mansour A. Parsi, Guru Trikudanathan, Manoop S. Bhutani, Arvind J. Trindade, Joshua Melson, and Rabindra R. Watson

Subjects
medicine.medical_specialty, Radiofrequency ablation, business.industry, medicine.medical_treatment, Gastroenterology, Gastric antral vascular ectasia, Arteriovenous malformation, Cryotherapy, medicine.disease, Ablation, law.invention, Surgery, 03 medical and health sciences, 0302 clinical medicine, law, 030220 oncology & carcinogenesis, Hemostasis, Barrett's esophagus, medicine, 030211 gastroenterology & hepatology, Radiology, Nuclear Medicine and imaging, business, Gastrointestinal endoscopy
Abstract

Endoscopic cryotherapy has shown safety and efficacy in the ablation of mucosal lesions such as dysplastic BE and for hemostasis of bleeding lesions such as GAVE and radiation proctopathy. The ease of use and the relatively low cost of cryotherapy make it a potentially attractive treatment modality for these indications.

Published
2017
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24. Devices for use with EUS

Author

Nirav Thosani, Zachary L. Smith, Subhas Banerjee, Udayakumar Navaneethan, Michael A. Manfredi, John T. Maple, Joo Ha Hwang, Shelby Sullivan, Mansour A. Parsi, Adam Goodman, Harry R. Aslanian, and Rahul Pannala

Subjects
03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Text mining, business.industry, 030220 oncology & carcinogenesis, Gastroenterology, MEDLINE, Medicine, 030211 gastroenterology & hepatology, Radiology, Nuclear Medicine and imaging, Medical physics, business
Published
2017
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