Advanced Endoscopic Interventions

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Abdomen and Pelvis: 1.00

Radiography: 1.50
Procedures: 1.50
Thorax and Abdomen Procedures: 1.50

Registered Radiologist Assistant: 1.50
Procedures: 1.50
Abdominal Section: 1.50

Vascular-Interventional Radiography: 1.50
Procedures: 1.50
Nonvascular Procedures: 1.50

Outline

1. Introduction
2. Peroral Endoscopic Myotomy
   1. Indications and Preliminary Workup
   2. Endoscopic Technique
   3. Expected Postoperative Appearance
   4. Advantages and Complications
3. Endoscopic Submucosal Dissection
   1. Indications and Preoperative Imaging
   2. Technique
   3. Expected Postoperative Appearance
   4. Advantages and Complications
4. Endoscopic Bariatric Therapy
   1. Indications, Advantages and Preliminary Workup
   2. Endoscopic Technique
   3. Expected Postoperative Appearance
   4. Complications
5. EUS-Guided Drainage through LAMS and Covered Metal Stents
   1. Overview and Preoperative Imaging
   2. Endoscopic Techniques and Indications
      1. EUS-Guided Biliary Drainage
      2. EUS-Guided Drainage of the Gallbladder and Abscesses
      3. EUS-Directed Gastrojejunostomy
   3. Expected Postoperative Appearance
   4. Advantages and Complications
6. Conclusion

Objectives

Upon completion of this course, students will:

1. list the advantages of an endoluminal approach
2. outline the radiologist’s role as intraluminal procedures become more common
3. define achalasia
4. choose the number of subtypes of achalasia
5. list the symptoms of achalasia
6. state the number of individuals affected by achalasia each year
7. list the preoperative achalasia testing requirements
8. list clinical findings suggestive of pseudoachalasia
9. differentiate between long and short-term treatments for achalasia
10. recall the success rate for laparoscopic Heller myotomy in the treatment of achalasia
11. describe the post-procedural appearance of Heller myotomy
12. choose the correct lumen size for best success in POEM procedures
13. list common POEM postprocedural findings
14. choose the percent of POEM patients that develop intraluminal dissection
15. state the clinical success rate of POEM
16. list benefits of POEM over laparoscopic Heller myotomy
17. state the percent of patients that experience persistent achalasia after unsuccessful POEM
18. list the areas of the body where the traditional treatment of early gastrointestinal tumors has been surgery
19. discern what patient population is eligible for the gastric endoscopic submucosal dissection procedure
20. list tumor aspects that are delineated at preoperative imaging for endoscopic submucosal dissection
21. list the classification systems for gastroesophageal tumors
22. list surgical methods for the treatment of gastroesophageal tumors
23. outline the advantages of endoscopic submucosal dissection as compared to surgery
24. list the complications associated with endoscopic submucosal dissection
25. know which imaging modality is used to assess endoscopic submucosal dissection patients for pneumoperitoneum, leakage of oral contrast material, and fluid collections
26. state how many people worldwide are affected by obesity
27. explain how bariatric surgery is effective
28. give the percentage of eligible patients that actually undergo bariatric surgery
29. state the body mass index required for endoscopic bariatric therapy
30. list the most common techniques for endoscopic bariatric therapy in the United States
31. explain the need for endoscopy prior to placement of an intragastric balloon
32. explain the goal of placement of an intragastric balloon
33. state the duration of endoscopically placed intragastric balloons
34. recall the spontaneous deflation rate for intragastric balloons
35. list the contraindications to intragastric balloons
36. state the goals of endoscopic sleeve gastroplasty
37. choose the imaging modality used to identify and locate the intragastric balloon and radiopaque valve
38. list the common adverse events of intragastric balloons
39. list the expanded use of covered metal stents and lumen apposing metal stents
40. state the shape of lumen apposing metal stents
41. choose the imaging procedure that confirmed stent placement following endoscopic ultrasound guided biliary drainage
42. state the common and expected finding following endoscopic ultrasound directed gastrojejunostomy
43. state adverse events that can result from endoscopic ultrasound guided drainage procedures