# Achalasia — GCMD Library living collection

Everything in the library about achalasia — built automatically from dossiers that name it.

Updated: n/a · 9 episodes · 191 cited statements

## Episodes
### Surgical Management
- [Laparoscopic Heller Myotomy](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252) — video · 3:32 · [machine version](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252.md)
- [SAGES/ALACE Symposium: Integrating New Technologies, Old Tricks, and Operative Approaches](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727) — video · 12:32 · [machine version](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727.md)

### Evidence & Research
- [How effective is POEM in children?](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758) — video · [machine version](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758.md)
- [Update Course Rewind: 2023 Top Ten Key Takeaways](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758) — video · 16:22 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758.md)
- [Ponsky and Gauderer invent the PEG tube](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724) — video · 7:03 · [machine version](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724.md)

### In-Depth Reviews
- [Update Course 2023 - Updates in Pediatric Achalasia Management](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270) — video · 26:54 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270.md)
- [Update Course Rewind: Updates in Achalasia 2023](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080) — video · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080.md)
- [Meet the Master: Jeffrey L. Ponsky, MD, FACS](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683) — video · 1:05:06 · [machine version](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683.md)
- [Endoscopy and Surgery](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720) — video · 11:29 · [machine version](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=0) Introduction and article selection context (Ep 1)
- [0:24](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=24) POEM study results in pediatric patients (Ep 1)
- [2:06](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=126) Clinical implications and future adoption (Ep 1)
- [0:06](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=6) Introduction to Heller myotomy and procedural overview (Ep 2)
- [1:30](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=90) Case presentation and trocar placement (Ep 2)
- [2:10](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=130) Myotomy technique without energy (Ep 2)
- [3:00](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=180) Completion of myotomy, fundoplication, and outcome (Ep 2)
- [0:03](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=3) Introduction and Achalasia Classification (Ep 3)
- [5:10](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310) Treatment Options and Fundoplication Debate (Ep 3)
- [11:14](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=674) Management of Recurrent Symptoms (Ep 3)
- [16:48](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1008) POEM Technique and Outcomes (Ep 3)
- [21:13](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1273) Dissemination and Training Challenges (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=0) Achalasia Classification and Diagnosis (Ep 4)
- [2:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=165) Surgical Management: Heller Myotomy vs POEM (Ep 4)
- [5:03](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=303) Management of Recurrent Symptoms (Ep 4)
- [8:24](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=504) Summary and Conclusion (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=0) Introduction and POEM Procedure for Achalasia (Ep 5)
- [1:52](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=112) Blunt Cerebrovascular Injury Screening (Ep 5)
- [3:12](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=192) Early Discharge After Pyloromyotomy (Ep 5)
- [4:36](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=276) ICG for Sentinel Node Identification (Ep 5)
- [6:21](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=381) Anal Dilations Following PSARP (Ep 5)
- [7:58](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=478) Fertility Preservation in Pediatric Oncology (Ep 5)
- [9:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=580) Massive Transfusion Protocol (Ep 5)
- [11:24](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=684) Ovarian Torsion Management (Ep 5)
- [12:54](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=774) Total Pancreatectomy with Islet Auto-Transplantation (Ep 5)
- [14:22](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=862) Blunt Hepatosplenic Trauma Management (Ep 5)
- [0:08](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=8) Early Life and Path to Surgery (Ep 6)
- [3:38](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=218) Entry into Endoscopy and the Scope in the Trunk (Ep 6)
- [10:40](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=640) Invention of PEG and Early Academic Career (Ep 6)
- [22:07](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1327) Mount Sinai Years and Academic Philosophy (Ep 6)
- [28:13](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1693) Leadership in ASGE and SAGES (Ep 6)
- [34:49](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2089) NOTES Era and Noscar Formation (Ep 6)
- [40:00](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2400) Cleveland Clinic Tenure and Current Practice (Ep 6)
- [53:24](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3204) Intramural Surgery and Future of Endoscopy (Ep 6)
- [0:06](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=6) History of Surgeons in Endoscopy: From Fiber Optics to Therapeutic Applications (Ep 7)
- [3:39](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=219) Endoscopy as Integral to Modern Surgical Practice (Ep 7)
- [6:05](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=365) Advanced Endoscopic Techniques and Surgeon-Gastroenterologist Collaboration (Ep 7)
- [8:36](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=516) Future Vision: Transmural Surgery, Robotics, and Endoscopic Innovation (Ep 7)
- [0:00](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=0) Early endoscopy training and territorial disputes (Ep 8)
- [2:48](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=168) Development and commercialization of the PEG tube (Ep 8)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- POEM (peroral endoscopic myotomy) provides 360 degrees of options to perform myotomy, whereas with Heller myotomy you have maybe 180 degrees and must worry about the vagus nerve. (clinical) [Ep 5 · 1:06](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=66)
- POEM can be performed after a failed Heller or previous POEM by choosing a different side for dissection, avoiding burned bridges. (clinical) [Ep 5 · 1:22](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=82)
- POEM does not require dissection of the hiatus, reducing concern for reflux. (clinical) [Ep 5 · 1:32](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=92)
- A patient with delayed diagnosis stroke from a missed BCVI prompted the institution to create a routine BCVI screening protocol requiring CTA head and neck for at-risk patients. (clinical) [Ep 5 · 2:24](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=144)
- If you are giving blood in the trauma bay, you need to activate MTP—giving blood equals MTP activation. (guideline) [Ep 5 · 10:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=615)
- For bad trauma with unstable or abnormal patients, whole blood would be the best option. (opinion) [Ep 5 · 10:39](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=639)
- The blood bank has not been able to provide whole blood for pediatric patients because it needs to be irradiated. (clinical) [Ep 5 · 10:48](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=648)
- The goal is 1:1:1 ratio of blood products (packed red blood cells:FFP:platelets), with FFP given after blood. (guideline) [Ep 5 · 10:53](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=653)
- Most hospital trauma coolers do not initially contain platelets, requiring separate call for platelets through MTP or direct request. (clinical) [Ep 5 · 10:58](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=658)
- In the acute postoperative period after TPIAT, glucose must be managed externally; all patients are on insulin in the ICU to avoid stressing the islet cells, allowing them to implant and find new vessels from the liver without doing work. (clinical) [Ep 5 · 13:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=807)
- In one institution's practice, 80% of pediatric trauma patients are transfers who have already had CBC at the referring hospital; hemodynamically normal children go to the floor without repeat hemoglobin. (clinical) [Ep 5 · 15:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=927)
- The three types of achalasia (Chicago classification) all require the same treatment approach, but type 2 responds best to surgery while type 3 has the worst outcomes (clinical) [Ep 3 · 1:41](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=101)
- Type 3 achalasia does not respond well to treatments and recurrences happen much more frequently in patients with type 3 (clinical) [Ep 3 · 1:41](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=101)
- The Eckardt score consists of four components: weight loss, dysphagia, chest pain, and regurgitation, used both for diagnosis and clinical follow-up — Mikhail Petrozan (clinical) [Ep 3 · 4:02](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=242)
- At Children's National, fundoplication is not offered with Heller myotomy because anterior wraps have caused esophageal torquing as children grow, requiring takedown of the wrap (clinical) [Ep 3 · 5:10](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- Approximately 50% of pediatric achalasia patients have had some intervention (dilation or Botox) before definitive surgery — Tim Kaine (epidemiological) [Ep 3 · 5:10](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- Botox injection causes significant scar tissue formation, while prior dilations cause minimal fibrosis that is not problematic during surgery — Tim Kaine (clinical) [Ep 3 · 5:10](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- The standard myotomy extends approximately 2 centimeters onto the stomach and 4-5 centimeters up the esophagus, for a total average length of 6-7 centimeters — Tim Kaine (clinical) [Ep 3 · 12:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=726)
- Symptoms within one year after myotomy suggest incomplete myotomy, while later recurrence may represent true recurrent achalasia related to growth — Tim Kaine (opinion) [Ep 3 · 12:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=726)
- Manometry in achalasia patients often continues to show abnormal findings even after successful treatment, making it less useful for post-operative surveillance — Mikhail Petrozan (clinical) [Ep 3 · 13:19](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=799)
- Endoflip measures esophageal distensibility and diameter, providing real-time feedback during myotomy to determine adequacy of the procedure (clinical) [Ep 3 · 15:41](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=941)
- The first human POEM case was performed by Inoue in 2010 (clinical) [Ep 3 · 16:48](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1008)
- Children's National performed their first POEM in 2015 after a two-year process to obtain equipment, with initial cases having conversion to Heller as backup (clinical) [Ep 3 · 17:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- POEM offers 360 degrees of myotomy options compared to approximately 180 degrees with laparoscopic Heller, and avoids hiatal dissection which reduces reflux risk (clinical) [Ep 3 · 17:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- In the Children's National series of 73 POEM cases, the re-intervention rate requiring balloon dilation within one year was 15%, similar to their historical Heller experience — Tim Kaine (epidemiological) [Ep 3 · 17:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- Five redo POEM procedures were performed, with three of the five being in patients with type 3 achalasia who presented with recurrent symptoms within one year — Tim Kaine (epidemiological) [Ep 3 · 17:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- In the Children's National POEM series, 11% were type 3 achalasia (higher than most literature), 62% were type 2, with type 2 patients having the best outcomes — Tim Kaine (epidemiological) [Ep 3 · 17:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- Pediatric patients biopsied one year after POEM showed a reflux rate of approximately 5%, compared to 50% in adult POEM patients — Mikhail Petrozan (epidemiological) [Ep 3 · 8:59](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=539)
- Type 2 achalasia patients have essentially no peristalsis, so opening the LES allows them to swallow effectively, while type 1 patients have spastic esophagus causing more persistent symptoms — Tim Kaine (clinical) [Ep 3 · 17:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- Children's National currently performs approximately 15 POEM procedures per year, with initial years having much lower volumes (2-3 cases) (epidemiological) [Ep 3 · 17:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- Many patients are now specifically requesting POEM after doing their own research, rather than considering Heller myotomy — Whit Holcomb (opinion) [Ep 3 · 24:03](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1443)
- The POEM technique has been successfully adapted for pyloric myotomy (G-POEM) in gastroparesis patients (clinical) [Ep 3 · 25:26](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1526)
- Only approximately 10% of pediatric surgeons perform thoracoscopic tracheoesophageal fistula repair, illustrating the challenge of disseminating advanced techniques — Whit Holcomb (epidemiological) [Ep 3 · 22:45](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1365)
- In all cases of achalasia, the lower esophageal sphincter fails to relax at the right time, but depending on the rest of the esophageal movements, there are three types of achalasia. — Mikol Petrossian (clinical) [Ep 4 · 0:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=27)
- In type one achalasia, the esophagus barely contracts, so food moves down because of gravity alone. — Mikol Petrossian (clinical) [Ep 4 · 1:30](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=90)
- In type two achalasia, pressure builds up in the esophagus, causing it to become compressed. — Mikol Petrossian (clinical) [Ep 4 · 1:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=100)
- In type three achalasia, there are abnormal contractions on the bottom of the esophagus where it meets the stomach. — Mikol Petrossian (clinical) [Ep 4 · 1:50](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=110)
- Type three achalasia does not respond well to treatments, and recurrences happen much more in patients with type three achalasia. — Mikol Petrossian (clinical) [Ep 4 · 2:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=120)
- All three types of achalasia respond to myotomy of the lower esophageal sphincter, but the outcomes are a little different. — Mikol Petrossian (clinical) [Ep 4 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=135)
- Type two achalasia is the most common and responds the best to surgery. — Mikol Petrossian (clinical) [Ep 4 · 2:25](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=145)
- The Eckardt score is the grading system most frequently used for the evaluation of symptoms, status, and efficacy of achalasia treatment, consisting of weight loss, dysphagia, chest pains, and regurgitation. — Mikol Petrossian (clinical) [Ep 4 · 2:32](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=152)
- Laparoscopic Heller myotomy is probably standard of care in pediatrics and is the tried and true approach for achalasia. — Whit Holcomb (opinion) [Ep 4 · 2:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=165)
- There is a large and increasing experience in POEM in the world. — Whit Holcomb (epidemiological) [Ep 4 · 3:05](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=185)
- Laparoscopic Heller myotomy is probably the gold standard procedure as of today. — Mikol Petrossian (opinion) [Ep 4 · 3:10](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=190)
- In the adult literature, if a Heller is done, there's a fair amount of good literature showing that you don't need to do a fundoplication. — Mikol Petrossian (clinical) [Ep 4 · 3:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=220)
- In the current population of pediatric patients who had POEM and were biopsied a year out, the rate of reflux is about 5%, compared to around 50% in adults. — Mikol Petrossian (epidemiological) [Ep 4 · 3:52](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=232)
- Reflux tends to be much less common in kids compared to adults after achalasia surgery. — Timothy Kane (clinical) [Ep 4 · 4:02](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=242)
- 50% of pediatric achalasia patients had some intervention before Heller myotomy, whether Botox or dilatations. — Whit Holcomb (epidemiological) [Ep 4 · 4:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=259)
- Botox is not used as commonly anymore because people are learning it causes a lot of scar tissue. — Whit Holcomb (clinical) [Ep 4 · 4:30](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=270)
- Many patients have had dilatations before Heller myotomy and the fibrosis is pretty minimal, so it is not recognized too much during surgery. — Whit Holcomb (clinical) [Ep 4 · 4:38](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=278)
- In kids who have had Hellers or POEMs before, you have to get into a different plane because it's pretty scarred. — Whit Holcomb (clinical) [Ep 4 · 4:48](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=288)
- Fundoplications are not recommended at the time of laparoscopic Heller myotomy, as they can cause torsion in the esophagus and recurrence of symptoms. — Timothy Kane (guideline) [Ep 4 · 4:55](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=295)
- An incomplete myotomy is basically not going far enough down during the initial surgery. — Mikol Petrossian (clinical) [Ep 4 · 5:52](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=352)
- Recurrent achalasia is categorized as related to growth, such as when a young child who had surgery grows significantly. — Mikol Petrossian (clinical) [Ep 4 · 6:05](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=365)
- If a child has symptoms within a year of surgery, it is likely an incomplete myotomy. — Mikol Petrossian (clinical) [Ep 4 · 6:18](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=378)
- Recurrent achalasia means the patient had achalasia, resolved symptoms after surgery, and due to growth presents with symptoms again after a long period of time, meaning more than one year. — Mikol Petrossian (clinical) [Ep 4 · 6:50](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=410)
- An incomplete myotomy is a patient that never fully resolved symptoms or did so for only a short period of time after surgery. — Mikol Petrossian (clinical) [Ep 4 · 7:05](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=425)
- For patients with prior achalasia surgery presenting with symptoms, investigation should include manometry, EGD, and biopsy to determine if the issue is a wrap problem, incomplete myotomy, or recurrent achalasia. — Mikol Petrossian (clinical) [Ep 4 · 7:17](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=437)
- Manometry will sometimes show achalasia that never goes away, with the same manometry findings, so kids are not routinely sent for manometry unless confirming achalasia from a different institution or if readings are equivocal. — Whit Holcomb (clinical) [Ep 4 · 7:35](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=455)
- EndoFLIP is a machine with a soft balloon that measures esophageal distensibility and diameter, used through endoscopy to determine if the myotomy was long enough. — Whit Holcomb (clinical) [Ep 4 · 8:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=480)
- The study examined 117 patients across 14 different hospitals on three different continents — Alex Gibbons (epidemiological) [Ep 1 · 0:24](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=24)
- POEM in children achieved about 91% clinical efficacy in terms of significant decrease in the Eckardt score — Alex Gibbons (clinical) [Ep 1 · 0:24](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=24)
- The Eckardt score is a score used to measure achalasia symptoms — Alex Gibbons (clinical) [Ep 1 · 0:24](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=24)
- POEM had about a 15% postoperative reflux incidence in children — Alex Gibbons (clinical) [Ep 1 · 0:24](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=24)
- Unlike Heller myotomy, POEM does not include any kind of anti-reflux procedure — Alex Gibbons (clinical) [Ep 1 · 0:24](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=24)
- The 90% efficacy and 15% reflux rate after POEM in children are pretty similar to what is seen in adults — Alex Gibbons (clinical) [Ep 1 · 0:24](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=24)
- The study showed that POEM is effective and safe in children — Alex Gibbons (clinical) [Ep 1 · 0:24](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=24)
- POEM has become not only popular but almost approaching standard of care in adults, though not there yet (opinion) [Ep 1 · 2:06](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=126)
- POEM is not seen often in children currently (epidemiological) [Ep 1 · 2:06](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=126)
- POEM will likely need to take place in the pediatric population more often as results are encouraging (opinion) [Ep 1 · 2:06](https://origin-library.globalcastmd.com/watch/how-effective-is-poem-in-children-1758?t=126)
- Modern endoscopy began with Basil Hersowitz in the late 1950s when he integrated flexible fiber optic technology to produce endoscopic instruments which could go through the mouth or rectum to produce images. — Jeff Ponsky (clinical) [Ep 7 · 0:59](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=59)
- Surgeons and gastroenterologists were involved in endoscopy from the very beginning. — Jeff Ponsky (clinical) [Ep 7 · 1:29](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=89)
- Gastroenterologists such as Gene Oberholt and Jerry Way developed diagnostic applications of endoscopy. — Jeff Ponsky (clinical) [Ep 7 · 1:50](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=110)
- Surgeons saw the therapeutic applications of endoscopy. — Jeff Ponsky (clinical) [Ep 7 · 2:08](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=128)
- Hiromi Shia and Bill Wolf developed polypectomy by putting a metal wire around polyps and applying electricity to remove them. — Jeff Ponsky (clinical) [Ep 7 · 2:17](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=137)
- Greg Stigman applied the principle of banding hemorrhoids in the rectum to esophageal varices. — Jeff Ponsky (clinical) [Ep 7 · 2:37](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=157)
- Michael Godard and Jeff Ponsky applied surgical principles of percutaneous techniques to place feeding tubes using the endoscope to guide the procedure. — Jeff Ponsky (clinical) [Ep 7 · 2:50](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=170)
- Nipsa Hendra, a surgeon in Germany, developed the first stenting of the bile duct. — Jeff Ponsky (clinical) [Ep 7 · 3:20](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=200)
- Surgeons have been involved in the advances in endoscopy, particularly the therapeutic advances. — Jeff Ponsky (opinion) [Ep 7 · 3:31](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=211)
- Bariatric and gastrointestinal surgeons today use endoscopy to look at their anastomoses and test them after surgery. — Jeff Ponsky (clinical) [Ep 7 · 4:30](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=270)
- Surgeons use endoscopy to stent leaks or perform therapeutic stenting of strictures. — Jeff Ponsky (clinical) [Ep 7 · 4:42](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=282)
- Endoscopy for surgeons today is a technique used to augment surgical procedures. — Jeff Ponsky (opinion) [Ep 7 · 4:59](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=299)
- Not all surgeons perform ERCP. — Jeff Ponsky (clinical) [Ep 7 · 5:07](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=307)
- Surgeons in bariatric surgery use endoscopy daily to assess surgical results, look for leaks, stent leaks, place drainage tubes, and improve treatment of complications. — Jeff Ponsky (clinical) [Ep 7 · 5:12](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=312)
- Endoscopy is part of what surgeons do today. — Jeff Ponsky (opinion) [Ep 7 · 5:31](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=331)
- Surgeons were the leaders in developing advanced endoscopic techniques because they asked what therapeutic procedures could be performed through the endoscope. — Jeff Ponsky (opinion) [Ep 7 · 6:05](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=365)
- Endoscopic submucosal dissection can be used to remove T2 tumors and extensive spreading tumors of the colon without the need for surgery. — Jeff Ponsky (clinical) [Ep 7 · 6:22](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=382)
- Emory Gorgon at the Cleveland Clinic has extensive experience in endoscopic submucosal dissection, including in the colon. — Jeff Ponsky (clinical) [Ep 7 · 6:38](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=398)
- Pre-malignant and early malignant lesions in the esophagus can be removed endoscopically. — Jeff Ponsky (clinical) [Ep 7 · 6:50](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=410)
- Division of esophageal muscles to treat achalasia can be performed endoscopically where surgery was previously required. — Jeff Ponsky (clinical) [Ep 7 · 6:54](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=414)
- Endoscopic techniques augment surgery rather than replace it, allowing selection of the right procedure for the right patient. — Jeff Ponsky (opinion) [Ep 7 · 7:09](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=429)
- The only place surgeons and gastroenterologists fail is when they fail to work together. — Jeff Ponsky (opinion) [Ep 7 · 7:35](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=455)
- The gastroenterology community excels at endoscopic ultrasound, which has led to tremendous therapeutic advances. — Jeff Ponsky (opinion) [Ep 7 · 7:45](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=465)
- The ultimate potential of endoscopic ultrasound will not be reached unless surgeons and gastroenterologists work together. — Jeff Ponsky (opinion) [Ep 7 · 7:50](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=470)
- At the Cleveland Clinic, surgeons and gastroenterologists work together, combining surgical and endoscopic techniques. — Jeff Ponsky (clinical) [Ep 7 · 8:03](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=483)
- Collaboration between surgeons and gastroenterologists augments the ability of endoscopy and extends the capacity of the specialty. — Jeff Ponsky (opinion) [Ep 7 · 8:26](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=506)
- In 10 years, the field will not recognize what is being done today in endoscopy. — Jeff Ponsky (opinion) [Ep 7 · 8:37](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=517)
- Transmural surgery will be possible in the future, including performing resections of pieces of bowel, removing tumors, and sewing up the lumen endoscopically. — Jeff Ponsky (opinion) [Ep 7 · 8:56](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=536)
- Gastrointestinal anastomoses will be performed endoscopically or using combined endoscopic and percutaneous techniques in the future. — Jeff Ponsky (opinion) [Ep 7 · 9:18](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=558)
- Surgical complications will be managed endoscopically in the future using ultrasound and endoscopy. — Jeff Ponsky (opinion) [Ep 7 · 9:32](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=572)
- New modalities will be integrated into endoscopy to deal with biliary disease, colonic disease, pancreatic disease, gastric disease, and inflammatory bowel disease. — Jeff Ponsky (opinion) [Ep 7 · 9:42](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=582)
- The robot refines surgical maneuvers and helps perform procedures better and more exactly. — Jeff Ponsky (opinion) [Ep 7 · 10:25](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=625)
- Jeff Ponsky was initially a critic of robotics in laparoscopic surgery when it first began because it was expensive and he thought it unnecessary. — Jeff Ponsky (opinion) [Ep 7 · 10:35](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=635)
- Robotics must be integrated into everything surgeons do. — Jeff Ponsky (opinion) [Ep 7 · 10:47](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=647)
- Robotics will be used with flexible endoscopy just as it has been used with colorectal and intestinal surgery. — Jeff Ponsky (opinion) [Ep 7 · 10:52](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=652)
- Flexible fiber optic gastrointestinal endoscopy began around 1958 when Hersowitz at the University of Michigan developed a method using glass fibers to transmit images. — Todd Ponsky (clinical) [Ep 8 · 0:12](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=12)
- In the 1960s, flexible endoscopy was used only for visualization of the GI tract without therapeutic interventions. — Todd Ponsky (clinical) [Ep 8 · 0:34](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=34)
- In the early 1970s, Shina, a surgeon in New York, developed the ability to remove polyps from the GI tract endoscopically. — Todd Ponsky (clinical) [Ep 8 · 0:45](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=45)
- Endoscopic polyp removal was significant because it enabled removal of polyps before they became cancer. — Todd Ponsky (clinical) [Ep 8 · 0:48](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=48)
- The chief of gastroenterology at Case Western Reserve University refused to train surgical residents in endoscopy in the early 1970s. — Todd Ponsky (clinical) [Ep 8 · 1:38](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=98)
- After completing approximately 500 endoscopy cases during training in Canton, Ohio, the speaker was again refused permission to participate in endoscopy training at Case Western Reserve because he was a surgeon. — Todd Ponsky (clinical) [Ep 8 · 2:09](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=129)
- By the end of residency, the speaker had displaced the gastroenterology service at University Hospitals through independent endoscopy practice using a personally owned endoscope. — Todd Ponsky (clinical) [Ep 8 · 3:02](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=182)
- Children with brain damage often required long-term feeding tubes. — Todd Ponsky (clinical) [Ep 8 · 3:18](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=198)
- The speaker and Michael Gauderer developed a technique to place feeding tubes endoscopically through the abdominal wall. — Todd Ponsky (clinical) [Ep 8 · 3:18](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=198)
- The PEG tube procedure was probably the beginning of minimally invasive surgery. — Todd Ponsky (opinion) [Ep 8 · 3:44](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=224)
- The speaker moved to Mount Sinai Hospital in 1979, almost 40 years before this presentation, and began performing PEG tube placement in adults. — Todd Ponsky (clinical) [Ep 8 · 3:51](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=231)
- Olympus, Ross Laboratories, and Eaton Laboratory all declined interest in commercializing the PEG tube when initially contacted. — Todd Ponsky (clinical) [Ep 8 · 4:09](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=249)
- Marlon Yonker owned a small endoscopy company called American Endoscopy and agreed to manufacture the PEG tube. — Todd Ponsky (clinical) [Ep 8 · 4:19](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=259)
- American Endoscopy was sold to Bard Endoscopy in 1986. — Todd Ponsky (clinical) [Ep 8 · 4:40](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=280)
- The PEG tube is now used and overused throughout the world. — Todd Ponsky (opinion) [Ep 8 · 4:53](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=293)
- The PEG tube was the first minimally invasive surgical procedure. — Todd Ponsky (opinion) [Ep 8 · 4:56](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=296)
- In the era of PEG development, innovators could directly contact company representatives who would work collaboratively in garages and laboratories to develop prototypes. — Todd Ponsky (clinical) [Ep 8 · 5:04](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=304)
- Modern medical device innovation faces greater challenges due to FDA regulations compared to the 1970s-1980s era. — Todd Ponsky (opinion) [Ep 8 · 5:41](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=341)
- The PEG tube has become a standard procedure. — Todd Ponsky (clinical) [Ep 8 · 6:05](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=365)
- Surgical endoscopy now includes procedures to divide muscles for achalasia, a condition where people cannot swallow. — Todd Ponsky (clinical) [Ep 8 · 6:18](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=378)
- Surgical endoscopy is used to treat Zenker's diverticulum, an outpouching of the esophagus causing swallowing difficulty. — Todd Ponsky (clinical) [Ep 8 · 6:26](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=386)
- Surgery is now performed through the endoscope. — Todd Ponsky (clinical) [Ep 8 · 6:33](https://origin-library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=393)
- In 1973, Dr. Ponsky was refused endoscopy training by Case Western Reserve's gastroenterology department, with the chief stating 'we're not going to train a surgeon to do endoscopy.' — Jeffrey L. Ponsky (clinical) [Ep 6 · 4:49](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=289)
- Dr. Ponsky performed approximately 500 endoscopies during a 4-6 month fellowship with Jim King in Canton, Ohio in 1974. — Jeffrey L. Ponsky (clinical) [Ep 6 · 6:06](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=366)
- Early endoscopy disinfection consisted of washing scopes with green soap and hanging them to dry, without gloves even for colonoscopy, and without high-level disinfection or washing machines. — Jeffrey L. Ponsky (clinical) [Ep 6 · 10:04](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=604)
- Dr. Ponsky published the first report of endoscopic tattooing with India ink in 1975 to mark colonic lesions for surgical localization. — Jeffrey L. Ponsky (clinical) [Ep 6 · 29:06](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1746)
- Percutaneous endoscopic gastrostomy (PEG) was developed by Dr. Ponsky and Michael Gower in May 1979, with the first 5 cases performed in infants at Rainbow Babies and Children's Hospital. — Jeffrey L. Ponsky (clinical) [Ep 6 · 15:27](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=927)
- The first adult PEG procedures were performed at Mount Sinai Hospital shortly after the initial pediatric cases in 1979. — Jeffrey L. Ponsky (clinical) [Ep 6 · 15:40](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=940)
- PEG was presented at the ASGE plenary session in Salt Lake City in 1980, where Peter Cotton stated 'I'm only sorry that I didn't think of this.' — Jeffrey L. Ponsky (opinion) [Ep 6 · 16:01](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=961)
- Transillumination in infants was critical to PEG development because the light shone through the thin abdominal wall, allowing visualization of stomach apposition to the abdominal wall. — Jeffrey L. Ponsky (clinical) [Ep 6 · 17:20](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1040)
- Early PEG tubes were fashioned from Pezzer catheters with Bunsen burner tubing as bolsters and medicut IV catheters as dilators. — Jeffrey L. Ponsky (clinical) [Ep 6 · 18:02](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1082)
- The technique of stretching the rubber tube to make it thinner for easier insertion through the dilating catheter was discovered by accident while walking down a hospital hallway. — Jeffrey L. Ponsky (clinical) [Ep 6 · 18:38](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1118)
- Using a snare around the puncturing needle to grasp the suture proved more reliable than attempting to grab it with biopsy forceps during PEG placement. — Jeffrey L. Ponsky (clinical) [Ep 6 · 19:08](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1148)
- The concept underlying PEG is affixing a loop of bowel to the abdominal wall and creating a permanent tract, which can be applied to various anatomic sites including stomach, jejunum, and cecum. — Jeffrey L. Ponsky (clinical) [Ep 6 · 20:53](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1253)
- Dr. Ponsky published cecostomy using the PEG technique for Ogilvie syndrome in 1984. — Jeffrey L. Ponsky (clinical) [Ep 6 · 21:16](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1276)
- SAGES membership grew from 300 members when Dr. Ponsky became president in 1990 to 2,000 members by the end of his tenure, driven by the laparoscopic cholecystectomy revolution. — Jeffrey L. Ponsky (epidemiological) [Ep 6 · 32:48](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1968)
- Jacques Perrisat showed the first video of laparoscopic cholecystectomy at the SAGES meeting in Louisville, Kentucky in 1989. — Jeffrey L. Ponsky (clinical) [Ep 6 · 32:24](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1944)
- ASGE operates as a meritocracy requiring members to work through committees (membership, governing board, treasurer) over approximately 20 years before becoming president. — Jeffrey L. Ponsky (opinion) [Ep 6 · 33:18](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1998)
- Dr. Ponsky was the second surgeon to serve as ASGE president, after Ted Schrock. — Jeffrey L. Ponsky (clinical) [Ep 6 · 34:02](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2042)
- The Schindler Award from ASGE in 2002 was the most prestigious award in Dr. Ponsky's career because it represented recognition by gastroenterologists as an endoscopist who made significant contributions. — Jeffrey L. Ponsky (opinion) [Ep 6 · 34:11](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2051)
- The concept of NOTES originated from a laparoscopic surgeon performing needlescopic cholecystectomy who removed the gallbladder through a gastrotomy, though this was never published. — Jeffrey L. Ponsky (clinical) [Ep 6 · 36:23](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2183)
- Tony Kalloo and Sergei Kantsevoy at Johns Hopkins published animal cases of transgastric surgery using the Eagle Claw device with the Apollo Group in 2004. — Jeffrey L. Ponsky (clinical) [Ep 6 · 37:03](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2223)
- Reddy and Rao in India performed the first transgastric appendectomy and showed the video but never published the work. — Jeffrey L. Ponsky (clinical) [Ep 6 · 37:23](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2243)
- NOSCAR (Natural Orifice Surgery Consortium for Assessment and Research) was formed by surgeons and gastroenterologists doing NOTES research, with the acronym conceived by Nathaniel Soper over wine. — Jeffrey L. Ponsky (clinical) [Ep 6 · 38:24](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2304)
- PEG rescue—accessing the peritoneal cavity through a dislodged PEG tract to place a new tube—was the first NOTES procedure performed in humans in the United States under IRB protocol. — Jeffrey L. Ponsky (clinical) [Ep 6 · 38:50](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2330)
- POEM (peroral endoscopic myotomy) was first performed in humans by Haruhiro Inoue in Yokohama around 2007, though the tunneling concept was conceived earlier at IRCAD in France during the NOTES era. — Jeffrey L. Ponsky (clinical) [Ep 6 · 53:24](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3204)
- Eric Hungness at Northwestern taught Dr. Ponsky and Jeff Marks the POEM technique in the lab, then proctored their first 2 human cases approximately 7 years ago (circa 2012). — Jeffrey L. Ponsky (clinical) [Ep 6 · 54:17](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3257)
- Patients undergoing POEM report life-changing improvement, with many stating 'you changed my life' at follow-up. — Jeffrey L. Ponsky (clinical) [Ep 6 · 54:42](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3282)
- Peroral pyloromyotomy (POP) via a lesser-curve tunnel 25 cm in length has been performed in over 300 cases at Cleveland Clinic. — Jeffrey L. Ponsky (clinical) [Ep 6 · 55:15](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3315)
- Two-thirds to three-quarters of patients undergoing POP show improved or normalized gastric emptying. — Jeffrey L. Ponsky (clinical) [Ep 6 · 55:37](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3337)
- POP is essentially an outpatient procedure that does not cause significant harm. — Jeffrey L. Ponsky (clinical) [Ep 6 · 55:45](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3345)
- Intramural tunneling can be used to resect stromal tumors and leiomyomas of the esophagus and stomach. — Jeffrey L. Ponsky (clinical) [Ep 6 · 55:49](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3349)
- Zenker's diverticulotomy using a double-sided submucosal tunnel approach allows complete myotomy with mucosal closure using clips, enabling same-day discharge. — Jeffrey L. Ponsky (clinical) [Ep 6 · 56:22](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3382)
- Robotic endoscopic platforms will enable surgical techniques including tissue manipulation, knot-tying, and full-thickness resection from a console, similar to robotic surgery. — Jeffrey L. Ponsky (opinion) [Ep 6 · 57:21](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3441)
- A step trocar (radially expanding surgical trocar) can be used through a PEG tract to place a large-bore gastrostomy tube when the esophagus is too stenotic to allow standard PEG tube passage. — Jeffrey L. Ponsky (clinical) [Ep 6 · 58:45](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3525)
- Surgeons interested in making endoscopy a major part of their career should complete a fellowship in advanced endoscopy to ensure their credentials cannot be challenged. — Jeffrey L. Ponsky (opinion) [Ep 6 · 61:00](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3660)
- At age 72, Dr. Ponsky performs approximately 1,200 endoscopies annually at Cleveland Clinic, working at multiple sites including monthly trips to Florida. — Jeffrey L. Ponsky (clinical) [Ep 6 · 51:15](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3075)
- In earlier days, separate individual ports provided more functionality and flexibility than multi-hole platforms for single-port surgery. (opinion) [Ep 9 · 1:08](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=68)
- Current multi-hole platforms have improved functionality compared to earlier versions. (clinical) [Ep 9 · 1:25](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=85)
- Multiple puncture holes in fascia was a concern with separate trocar approaches. (clinical) [Ep 9 · 1:34](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=94)
- Most current multi-hole platforms have a skin barrier protector sleeve and require only one fascial incision. (clinical) [Ep 9 · 1:39](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=99)
- The mass population is probably not going to adopt the robot for single-site surgery. (opinion) [Ep 9 · 2:00](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=120)
- Different types of myotomy for achalasia have been tried, starting from the Heller one, circular or spiral. — Silvanna (clinical) [Ep 9 · 2:23](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=143)
- Myotomies that kept both longitudinal and circular layers leaving only mucosa had complications such as outpouching. — Silvanna (clinical) [Ep 9 · 2:23](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=143)
- Cutting just the circular layer provides length but may cause dilation problems because only mucosa remains without muscular support. — Silvanna (clinical) [Ep 9 · 2:44](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=164)
- In animal model testing with stretching technique, total circular myotomy provides length but the esophagus loses strength. — Silvanna (clinical) [Ep 9 · 3:09](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=189)
- Bilateral myotomy is capable of elongating the esophagus while keeping good compliance. — Silvanna (clinical) [Ep 9 · 3:09](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=189)
- Magnets are very difficult to control their force and energy once used. — Romero (clinical) [Ep 9 · 4:08](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=248)
- LINX is a potential in-between therapy, possibly more effective than current endoluminal therapies but maybe not as much of a barrier as Nissen, though potentially more physiologic. — Brian (opinion) [Ep 9 · 4:21](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=261)
- LINX is a rosary of magnets that slide along so when swallowing, the bolus pushes the magnets apart and they lose some attraction force, making it more physiologic. — Brian (clinical) [Ep 9 · 4:38](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=278)
- LINX developers seem to have figured out how to place it without erosions. — Brian (clinical) [Ep 9 · 4:52](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=292)
- If a patient is already suffering what is believed to be a complication of gastroesophageal reflux disease (Barrett's esophagus), we should be aggressive about managing it rather than treating it expectantly, similar to a colon polyp. — Brian (opinion) [Ep 9 · 5:31](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=331)
- It is not clear whether radiofrequency ablation is necessary for non-dysplastic Barrett's esophagus in some people's minds. — Brian (opinion) [Ep 9 · 5:51](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=351)
- Data supporting radiofrequency ablation for non-dysplastic Barrett's will be coming down the road, though it takes a long time to generate. — Brian (opinion) [Ep 9 · 5:59](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=359)
- In the New England Journal of Medicine study, there was a significant rate of buried glands in both radiofrequency ablation and control groups. — Brian (clinical) [Ep 9 · 6:27](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=387)
- The percent of buried glands at baseline before any intervention was around 15% in the placebo group, which went up, while in the treatment group it went down. — Brian (clinical) [Ep 9 · 6:36](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=396)
- Buried glands are starting to be understood as a natural state of Barrett's esophagus. — Brian (clinical) [Ep 9 · 6:53](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=413)
- Radiofrequency ablation definitely decreases buried glands and does so more than acid suppression and placebo. — Brian (clinical) [Ep 9 · 7:12](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=432)
- In settings where facilities are available and stones are known in the common bile duct ahead of time, direct common duct exploration is performed rather than ERCP. — Samuel (clinical) [Ep 9 · 8:07](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=487)
- Common bile duct exploration is done transcystically if possible, or by choledochotomy via regular laparoscopy if not. — Samuel (clinical) [Ep 9 · 8:27](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=507)
- In a review of 500 ERCPs from 10 different endoscopists, only 68% were able to clear the biliary tree. — Samuel (clinical) [Ep 9 · 8:58](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=538)
- In many Latin American countries, an endoscopist performs 100 ERCP cases over 10 years, not as everyday routine. — Samuel (epidemiological) [Ep 9 · 9:42](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=582)
- Gastric leaks and biliary leaks have very common closure rates and usually close in about 2 to 3 weeks. (clinical) [Ep 9 · 11:08](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=668)
- Stents for gastric and biliary leaks are typically left in place for 4 to 6 weeks because it is not a big deal to remove them. (clinical) [Ep 9 · 11:26](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=686)
- Chronic fistulas, especially tracheoesophageal fistulas managed for months through drainage, clips, and glues, require stents for much longer periods and have lower success rates. (clinical) [Ep 9 · 11:33](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=693)
- After stent removal, patients are studied with appropriate imaging: intraoperative cholangiogram for biliary leaks or upper GI study for gastrointestinal tract leaks to verify closure. (clinical) [Ep 9 · 12:02](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=722)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The gold standard for achalasia treatment is laparoscopic Heller myotomy. — The host summarizing the discussion [Ep 5 · 0:38](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=38)
- Blunt cerebrovascular injury (BCVI) occurs in 1.3% of all head trauma in the pediatric population. — The host summarizing the discussion [Ep 5 · 2:02](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=122)
- Nearly one-third of pediatric patients with BCVI will have a stroke, increasing mortality up to 20%. — The host summarizing the discussion [Ep 5 · 2:02](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=122)
- The Memphis score is the most sensitive scoring system for BCVI screening in pediatric head trauma patients. — The host summarizing the discussion [Ep 5 · 2:51](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=171)
- Patients under 37 weeks gestational age require overnight monitoring following anesthesia after pyloromyotomy, even if tolerating feeds shortly after surgery. — The host summarizing the discussion [Ep 5 · 3:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=225)
- Full-term babies over 4 weeks old may be eligible for discharge from PACU after pyloromyotomy. — The host summarizing the discussion [Ep 5 · 3:56](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=236)
- NSQIP data shows only 1.5% of pyloromyotomy patients were discharged on day of surgery, with no difference in odds of readmission or complications compared to overnight stay. — The host summarizing the discussion [Ep 5 · 4:01](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=241)
- ICG (indocyanine green) has become increasingly integrated into biliary-related surgeries such as cholecystectomies due to its hepatic excretion. — The host summarizing the discussion [Ep 5 · 4:46](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=286)
- Technetium-99 requires a special machine to detect and is difficult to control the injection timing. — The host summarizing the discussion [Ep 5 · 5:08](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=308)
- ICG technique is real-time in the operating room with equipment that is standard or soon to be standard in all laparoscopic towers. — The host summarizing the discussion [Ep 5 · 5:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=320)
- With ICG injection into the tumor, you can watch over 45-75 seconds as the ICG travels to the sentinel node with lights off under fluorescence. — The host summarizing the discussion [Ep 5 · 5:52](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=352)
- Recent studies have revealed a lack of firm correlation between anal dilations and stricture development following PSARP. — The host summarizing the discussion [Ep 5 · 6:39](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=399)
- Many PSARP patients have a colostomy and will undergo another procedure for colostomy closure, which is a perfect moment to perform strictureplasty if needed. — The host summarizing the discussion [Ep 5 · 7:02](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=422)
- The surgeon sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses whether dilations are needed based on the examination, informing families that strictureplasty may be needed later. — The host summarizing the discussion [Ep 5 · 7:13](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=433)
- Every society emphasizes fertility preservation counseling even when surgery is not planned for children facing gonadotoxic therapy. — The host summarizing the discussion [Ep 5 · 8:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=500)
- When a patient has a new cancer diagnosis or is approaching stem cell transplant, the fertility preservation counseling service is activated through an Epic order set, triggering consultation by advanced practice nurse, physician, or oncology team for risk assessment. — The host summarizing the discussion [Ep 5 · 8:36](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=516)
- In a prepubertal child, the ovary is about 2 centimeters in size, approximately the size of a grape, and laparoscopic oophorectomy is the best recommendation for ovarian tissue preservation. — The host summarizing the discussion [Ep 5 · 9:05](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=545)
- Laparoscopic oophorectomy is recommended to reduce the risk of hemorrhage and ensure remaining ovarian tissue is preserved for future fertility. — The host summarizing the discussion [Ep 5 · 9:17](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=557)
- Massive transfusion protocol (MTP) is a multidisciplinary process for rapidly obtaining blood and blood products for severely bleeding patients. — The host summarizing the discussion [Ep 5 · 9:49](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=589)
- Massive transfusion protocol should be activated after administering 20 mL/kg of blood in the trauma bay. — The host summarizing the discussion [Ep 5 · 11:08](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=668)
- Ovarian torsion often presents with a cystic area visible on ultrasound that may be less visible in the operating room due to edema. — The host summarizing the discussion [Ep 5 · 11:51](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=711)
- If the fallopian tube is black and edematous after detorsion and adequate time, consideration should be given to management of that tube. — The host summarizing the discussion [Ep 5 · 12:08](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=728)
- It is best to avoid removing the ovary in torsion because it may regain functionality even if it appears black. — The host summarizing the discussion [Ep 5 · 12:23](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=743)
- Doctor Breech advises against oophoropexy (ovarian fixation) and instead recommends detorsion with subsequent monitoring. — The host summarizing the discussion [Ep 5 · 12:31](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=751)
- Chronic pancreatitis causes pancreatic insufficiency and damage to islet cells. — The host summarizing the discussion [Ep 5 · 13:08](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=788)
- TPIAT involves complete removal of pancreas and spleen, extraction of islet cells in a specialized lab, then injection of those cells into the portal vein. — The host summarizing the discussion [Ep 5 · 13:17](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=797)
- Many chronic pancreatitis patients have gene mutations triggering recurrent attacks, causing the gland to replace normal cells with fibrosis. — The host summarizing the discussion [Ep 5 · 13:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=825)
- Performing surgical resection for chronic pancreatitis without islet cell extraction may result in continued pancreatitis attacks and increased diabetes risk due to reduced pancreatic parenchyma. — The host summarizing the discussion [Ep 5 · 13:55](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=835)
- The American Pediatric Surgical Association (APSA) released revised guidelines for blunt hepatosplenic trauma management including four categories: admission location, procedures, discharge timing, and post-discharge management. — The host summarizing the discussion [Ep 5 · 14:52](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=892)
- For grades 1 and 2 blunt liver and spleen trauma, hemodynamically stable patients can be monitored and considered for discharge from the emergency department. — The host summarizing the discussion [Ep 5 · 15:13](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=913)
- Data shows hemodilution occurs in trauma, and patients more likely to fail non-operative management have initial hemoglobin less than 9.25 g/dL. — The host summarizing the discussion [Ep 5 · 15:43](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=943)
- For blunt liver and spleen trauma, increasing evidence supports treating the patient based on signs and symptoms rather than solely on injury grade. — The host summarizing the discussion [Ep 5 · 16:04](https://origin-library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=964)
- Children account for approximately 5% of all patients with achalasia. — The host summarizing a resource [Ep 2 · 0:06](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=6)
- The Heller esophagocardiomyotomy is the most definitive treatment for achalasia. — The host summarizing a resource [Ep 2 · 0:20](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=20)
- The four major steps of Heller myotomy are mobilization of the distal esophagus, a long esophagomyotomy carried onto the stomach as a cardiomyotomy, and an anterior fundoplication to cover the myotomy and decrease gastroesophageal reflux. — The host summarizing a resource [Ep 2 · 0:35](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=35)
- The most critical part of the Heller operation is the myotomy, where mucosal perforations can occur, typically secondary to burns from an energy source such as hook cautery. — The host summarizing a resource [Ep 2 · 1:00](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=60)
- Myotomy can be performed in a precise manner without the use of any energy source. — The host summarizing a resource [Ep 2 · 1:20](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=80)
- An 8-centimeter silk suture is used to measure the distance from the diaphragm to the cardia during the procedure. — The host summarizing a resource [Ep 2 · 2:10](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=130)
- The posterior attachments of the esophagus to the hiatus are kept intact during mobilization. — The host summarizing a resource [Ep 2 · 2:20](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=140)
- An arthroscopic knife introduced through the abdominal wall is used to initiate the esophageal myotomy, then scissors deepen the myotomy. — The host summarizing a resource [Ep 2 · 2:30](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=150)
- A right-angle grasper spreads the muscle fibers, and once the longitudinal muscle is mobilized, traction in opposite directions achieves satisfactory separation without injury to the submucosa. — The host summarizing a resource [Ep 2 · 2:45](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=165)
- The myotomy proceeds from distal to proximal, with the outer longitudinal and inner circular layers well identified, including individual circular fibers which can be precisely divided by the tip of the instrument with the heel protecting the submucosa. — The host summarizing a resource [Ep 2 · 3:00](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=180)
- The dissection is bloodless when performed with this technique. — The host summarizing a resource [Ep 2 · 3:20](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=200)
- After reaching the proximal extent of the esophagus at the diaphragm, the direction of dissection is reversed to extend the myotomy onto the gastric cardia for approximately 2 centimeters. — The host summarizing a resource [Ep 2 · 3:25](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=205)
- The myotomy is tested by pulling the nasogastric tube back to the hiatus and performing air insufflation. — The host summarizing a resource [Ep 2 · 3:40](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=220)
- The procedure is completed with an anterior fundoplication. — The host summarizing a resource [Ep 2 · 3:50](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=230)
- The patient had near-complete resolution of symptoms postoperatively. — The host summarizing a resource [Ep 2 · 3:55](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=235)
- A postoperative contrast study confirmed resolution of the esophageal obstruction. — The host summarizing a resource [Ep 2 · 4:00](https://origin-library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=240)
- A 2015 IPEG survey showed 95% of pediatric surgeons would perform fundoplication with Heller myotomy — Tim Kaine summarizing the discussion [Ep 3 · 5:10](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- In adult literature, when Heller myotomy is performed, good evidence shows fundoplication is not necessary — Tim Kaine summarizing the discussion [Ep 3 · 5:10](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- The learning curve for POEM is approximately 20 cases, with mastery around 60 cases according to adult literature — The host summarizing the discussion [Ep 3 · 17:06](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- If there is a perforation of the anterior esophagus during laparoscopic esophageal myotomy, an anterior fundoplication can help with healing or preventing complications, but you can also put a couple stitches in it and be just fine. — Cecilia Gigena summarizing the discussion [Ep 4 · 5:03](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=303)
- EndoFLIP measures the diameter of the esophagus before and after myotomy and also measures distensibility index, which is the amount of pressure needed to distend the esophagus a certain amount. — Cecilia Gigena summarizing the discussion [Ep 4 · 8:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=500)
- There are accepted standards for normal distensibility index in adults, which are extrapolated to kids as treatment targets. — Cecilia Gigena summarizing the discussion [Ep 4 · 8:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=520)
- The gold standard treatment for achalasia is laparoscopic Heller myotomy, but POEM is increasing in popularity and is better for recurrences. — Cecilia Gigena summarizing the discussion [Ep 4 · 8:50](https://origin-library.globalcastmd.com/watch/update-course-rewind-updates-in-achalasia-2023-8080?t=530)
- Endoscopy training became a requirement for surgical residents during Jeff Ponsky's tenure at the American Board of Surgery. — Steve summarizes what Dr. Jeff Ponsky said [Ep 7 · 4:03](https://origin-library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=243)
- To achieve 85% success in cannulating and working the biliary tree, at least 100 ERCP cases are needed on average. — Samuel summarizing the discussion [Ep 9 · 9:23](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=563)
- Multiple authors have shown that exploration of the common bile duct is possible with decreased cost, same morbidity, and possibly even less morbidity than ERCP. — Samuel summarizing the discussion [Ep 9 · 9:42](https://origin-library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=582)

## Changelog
- Sep 27: 4 items added automatically
- Sep 25: 2 items added automatically
- Sep 21: 3 items added automatically

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://origin-library.globalcastmd.com/ai