Publications by authors named "D J Desilets"

Submucosal injection fluid and tattoo agents.

Gastrointest Endosc

November 2024

Background And Aims: EMR and endoscopic submucosal dissection (ESD) are minimally invasive endoscopic techniques, developed for the removal of benign and early malignant lesions throughout the GI tract. Submucosal injection of a marking agent can help to identify lesions during surgery. Endoscopic resection frequently involves "lifting" of the lesions by injection of a substance within the submucosal space to create a cushion for safe resection.

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Background: Achalasia is an esophageal motility disorder with three subtypes based on manometry that can treated with per-oral endoscopic myotomy (POEM). With the advent of impedance planimetry (EndoFLIP®), we hypothesized the three achalasia subtypes would have different pre-POEM EndoFLIP® diameter and distensibility index (DI) measurements but would be similar after POEM.

Methods: A single-institution, retrospective review of consecutive POEM cases by a single surgeon-endoscopist team from 04/07/2017 to 08/28/2023.

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Background: Per-oral endoscopic myotomy (POEM) has become an accepted minimally invasive alternative to Heller myotomy for the treatment of achalasia and other disorders of esophageal dysmotility. One associated adverse event is the inadvertent creation of capnoperitoneum. A proposed mechanism is that extension of the submucosal tunnel below the esophageal hiatus and onto the gastric wall leads to transmural perforation.

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Article Synopsis
  • The study explores the effects of submucosal tunnel (SMT) dissection on the success of per-oral endoscopic myotomy (POEM) for treating esophageal dysmotility, specifically looking at changes in luminal diameter and distensibility index (DI).
  • Researchers analyzed data from 66 POEM patients and found that SMT dissection alone led to significant changes in luminal diameter and DI, accounting for 38% and 30% of the total changes seen with complete POEM, respectively.
  • The results indicate that while SMT dissection impacts esophageal dimensions, the full benefits of POEM come from additional factors, suggesting that the submucosa could be targeted for improved treatments in achal
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Background: Achalasia is a rare disorder of esophageal motility that induces progressive intolerance to oral intake. Other esophageal dysmotility disorders include esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), hypercontractile esophagus (HE), and other minor disorders of peristalsis (MDP) and can present similarly to achalasia despite different pathophysiologies. Prior studies have demonstrated the safety and efficacy of POEM in the treatment of achalasia, but little is reported regarding POEM's role in treating non-achalasia esophageal dysmotility disorders (NAEDD).

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