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Volume 8 Journal of Gastrointestinal & Digestive System
ISSN: 2161-069X
Page 41
JOINT EVENT
Pediatric Gastro 2018
Digestive Diseases 2018
October 22-23, 2018
October 22-23, 2018 Berlin, Germany
3rd International Conference on
Digestive and Metabolic Diseases
Pediatric Gastroenterology Hepatology & Nutrition
13th International Conference on
&
Clinical Use of Liu-POEM and NOTES
Bingrong Liu
The GI Hospital of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
Introduction: With the commencement of clinical use, endoscopy now covers a wide range of usage for clinicalexamination
and minimally invasive surgery. It is a great trend and reality for such techniques to go further into a state of routine approaches
in clinical practice. Now, I am willing to introduce the excellence of initiation and development of gastrointestinal endoscopy
in three selected facets partly supported by our new development and techniques in our clinical practices and studies.
Liu-POEM: Peroral endoscopic myotomy (POEM): POEM was developed to provide a minimally invasive treatment for
esophageal achalasia. From this technique, we developed a modified POEM approach and named as Liu-POEM, which is no
need for creating a tunnel and hence shortens operation time and alleviates patient’s pains remarkably. Now, Liu-POEM has
been used by more and more endoscopists in the world. (1) Background. Esophageal achalasia is a primary motility disorder
involving absence of esophageal peristalsis, failure of the lower esophageal sphincter (LES) to relax, and cardiac diastolic
dysfunction. Peroral endoscopic myotomy (POEM) has emerged as an approach to treating esophageal achalasia. Although
POEM is credited with high success rates in the treatment of achalasia, the submucosal tunneling is time consuming and
commonly requires one-third to two-thirds of the total operation time. For the purpose of improving POEM procedure and
shortening operation time, we modified the POEM procedure by combining the procedures of myotomy and tunnellization
into an unit step. We named this approach as modified peroral endoscopic myotomy, the Liu-POEM. (2) Operational
procedures. 1). Creation of a 1cm submucosal tunnel at the right or back esophageal wall approximately 8 cm proximal to the
esophagogastric junction (EGJ).
Pure NOTES: (1) Introduction. Since Natural Orifice Transluminal Endoscopic Surgery (NOTES) was first described by
Anthony Kalloo, it has attracted tremendous interest from surgeons and gastroenterologists all around the world. Natural orifice
transluminal endoscopic surgery (NOTES) uses transvisceral access to the peritoneal cavity through mouth, rectal, colon, and
vagina ect.. Now, a number of endoscopic approaches can be performed by NOTES and Pure have performed A
series of operations by Pure NOTES, and the most successful one was transrectal gallbladder preserving cholecyctolithotomy
(TRGPC) and transrectal gallbladder preserving polypectomy (TRGPP) by pure NOTES, which was the first suchcase series in
human beings. (2). Operational procedures. The key steps for TRGPC and TRGPP are as below. Ultrasonic examination was
required for disease confirmation and assessment prior to operation. Under general anesthesia after routine preparations, the
patient was placed in a left recumbent position prior to the initiation of the procedure. A colonoscope was introduced into the
transverse colon and the colonic lumen was cleaned with normal saline through the endoscope and then the endoscope was
withdrawn from the colon. A detachable prototype balloon which was developed by our team was placed into the transverse
colon by a biopsy forceps and was inflated to block the colonic lumen with a suitable pressure inside the balloon (Fig. 1-A).
The distal colon cavity was irrigated with normal saline solution and disinfected with a 0.1% povidone-iodine solution. A
disinfected endoscope with a transparent cap mounted at the tip of it was used. To ensure a smooth advance of the endoscope
and the accuracy in spatial identification in the peritoneal cavity, the Trendelenburg’s position is suggested. After submucosal
saline injections, a 2 cm incision was made on the anterior rectal wall 15-20 cm from the anus by hook and IT knives.The
endoscope was advanced into the pelvic cavity, and an incision was made on the peritoneum by ahook knife to enable the
flexible endoscope pass through into the peritoneal cavity, and then the endoscope was advanced upward into the upper
peritoneal cavity with liver and gallbladder identified.
Conclution: In conclusion, minimally invasive surgery is now playing an important role in the fields of surgery and
gastroenterology. We believe, along with the innovations in new instruments and techniques, as well as our ceaseless
explorations of new things, more and more new approaches and procedures of gastroenterological endoscopy will come up
and be widely used in various clinical practices.
J Gastrointest Dig Syst 2018, Volume 8
DOI: 10.4172/2161-069X-C7-083