Per-oral endoscopic myotomy white paper summary

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Presentation transcript:

Per-oral endoscopic myotomy white paper summary Stavros N. Stavropoulos, MD, David J. Desilets, MD, Karl-Hermann Fuchs, MD, Christopher J. Gostout, MD, FASGE, Gregory Haber, MD, Haruhiro Inoue, MD, FASGE, Michael L. Kochman, MD, FASGE, Rani Modayil, MD, Thomas Savides, MD, FASGE, Daniel J. Scott, MD, Lee L. Swanstrom, MD, Melina C. Vassiliou, MD Gastrointestinal Endoscopy Volume 80, Issue 1, Pages 1-15 (July 2014) DOI: 10.1016/j.gie.2014.04.014 Copyright © 2014 Terms and Conditions

Figure 1 Expansion of the submucosal space at the gastric cardia with increased vascularity; note the spindle shaped veins best seen on the side of the muscularis. (Courtesy Winthrop University Hospital.) Gastrointestinal Endoscopy 2014 80, 1-15DOI: (10.1016/j.gie.2014.04.014) Copyright © 2014 Terms and Conditions

Figure 2 Palisading vessels. Long, thin palisading vessels are seen on the under side of the mucosa at the level of the gastroesophageal junction at 7 o'clock to 11 o'clock. (With permission Elsevier, Gastrointestinal Endoscopy Clinics of North America, 2013.) Gastrointestinal Endoscopy 2014 80, 1-15DOI: (10.1016/j.gie.2014.04.014) Copyright © 2014 Terms and Conditions

Figure 3 Increased submucosal vascularity in the gastric cardia. There is a wider submucosal space with large submucosal vessels that are seen in the gastric cardia. Large, penetrating branches of the left gastric artery can be seen as shown in this image. (Courtesy Winthrop University Hospital.) Gastrointestinal Endoscopy 2014 80, 1-15DOI: (10.1016/j.gie.2014.04.014) Copyright © 2014 Terms and Conditions

Figure 4 Bundles of aberrant inner longitudinal muscle fibers. Short bundles of aberrant inner longitudinal muscle fibers running in the submucosa and inserting into the circular layer of the muscularis propria are a marker that the level of the gastroesophageal junction has been reached. (With permission Elsevier, Gastrointestinal Endoscopy Clinics of North America, 2013.) Gastrointestinal Endoscopy 2014 80, 1-15DOI: (10.1016/j.gie.2014.04.014) Copyright © 2014 Terms and Conditions

Figure 5 Blue discoloration of gastric cardia mucosa. Blue discoloration of the cardia mucosa is seen on retroflexion (from the blue dye used in the submucosal injectate) once the submucosal tunnel is successfully extended to the cardia. (With permission Elsevier, Gastrointestinal Endoscopy Clinics of North America, 2013.) Gastrointestinal Endoscopy 2014 80, 1-15DOI: (10.1016/j.gie.2014.04.014) Copyright © 2014 Terms and Conditions