| Invited Lecture (JGES) |
| Sat. November 3rd 14:00 - 14:40 Room 13: Kobe International Conference Center International Conference Room |
| Endoscopic foregut surgery: The future is now! | |||
| Kenneth J Chang | |||
| UCI Medical Center, Chao Digestive Disease Center | |||
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| The foregut is defined as “the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver, pancreas, and part of the duodenum develop”. Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease (GERD), achalasia, esophageal Diverticulum, Barrett’s and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of Endoscopic Foregut Surgery. GERD: There are now several technologies available to effectively treat GERD with the ability to eliminate troublesome symptoms and the need for long-term proton pump inhibitors. For the first time, GI physicians and surgeons can perform fundoplication without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing long-term efficacy. Achalasia: Per-oral endoscopic myotomy (POEM) was developed in Japan and has spread worldwide as an alternative to the traditional Heller myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. An endoscopic solution is also quite near. Zenker’s Diverticulum: There is now a resurgence of endoscopic treatment of Zenker’s diverticulum, with improved technique and equipment (Z-POEM), more patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. Barrett’s Esophagus, Early esophageal cancer: While quite established in Asia, endoscopic submucosal dissection (ESD) is now becoming more mainstream in the west for the treatment of Barrett’s with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies (radiofrequency ablation, cryotherapy, photodynamic therapy), this entire spectrum of disease is managed predominately by endoscopy. Early gastric cancer and SMT’s of the stomach: ESD and now full thickness resection (FTR) is now possible to resect these lesions. Endoscopic suturing is used to close large defects and perforations. Gastric Outlet Obstruction (GOO): Whether caused by malignant or benign obstruction, endoscopic gastro-jejunostomy is now showing better results than enteral stenting in treating these patients. G-POEM is also emerging as a treatment option for patients with gastroparesis. Obesity: This has become an epidemic is many western countries and is becoming more prevalent in Asia as well. Endoscopic sleeve gastroplasty (ESG) is now becoming established an option, especially for obese patients with BMI between 30 and 35. Data show an average weight loss of 22 Kg after ESG with long-term data confirming sustainability. Endo-Hepatology: Finally, there are many new endoscopy interventions that have been developed for patients with liver disease. EUS-guided liver biopsy and EUS-guided portal pressure measurement are exciting new frontiers for the endo-hepatologists. |
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