POEM
Conference Name: Endoscopy Workshop- Nashik-Dec 2015
Surgeon(s)/Speaker(s): Dr. Amol Bapaye
Surgical Procedure: GI Endoscopy-POEM
Location: Kaushalya Hospital & Research Centre Nashik
Indexsteps
1. Submucosal Incision : * Submucosal incision in upper oesophagus 20 to 25 cms above co junction
2. Injection with dilute adrenaline : * Injection with dilute adrenaline with tinge of blue of methylene blue dye
3. To raise mucosal wheal : * To raise mucosal wheal
4. Incision on the raised mucosa : * Incision is taken on the raised mucosa to visualize sub mucous space with hybrid/Endoknife
5. Enlarging Submucous space : * Submucous space enlarged by small burst of electrocautery & movement of scope side to side
6. Serial injection of adrenaline : * Serial injection of adrenaline solution, followed by cutting of loose areolar tissue & advancing scope towards LES under the mucosa
7. A long submucosed tunnel created upto LES : * A long submucosed tunnel created upto LES
8. The submucosal tunnel extended : * The submucosal tunnel extended beyond LES inside stomach upto 3 to 4 cms
9. Scope withdraw & reinserted inside lumen : * Scope withdraw & reinserted inside lumen to check for mucosal integrity & length of tunnel & extention beyond LES
10. Scope reinserted : * Scope reinserted inside submucosal tunnel for 5cm
11. Myotomy begun by cutting muscle fibres : * Myotomy begun by cutting muscle fibres on the ventral side 5cms beyond mucosal cut , using Hybrid knife/IT knife
12. Myotomy extended across LES : * Myotomy extended across LES for 2cms beyond LES
13. Haemostasis checked : * Haemostasis checked
14. Scope withdraw inside oesophageal lumen : * Scope withdraw inside oesophageal lumen
15. Incision closed : * Submucosal incision closed using endo-clips
pre_post_measures
1. Preoperative measures : NBM for 24 hours :new: Esophageal Lavage to clean the oesophagus
Surgical Instruments
1. Triangular Tip (TT) Knife
2. Hybrid Knife
3. Insufflator
4. Endoscope
5. High end electrocautery without endocut