VideoGIE最新文献

{"title":"Retrograde device-assisted lumen-apposing metal stent insertion for candy cane syndrome","authors":"Anne Kimberly Lim-Fernandez MD ,&nbsp;Samuel Jun Ming Lim MRCP ,&nbsp;Chin Hong Lim MRCP ,&nbsp;Christopher Jen Lock Khor MRCP ,&nbsp;Damien Meng Yew Tan MRCP","doi":"10.1016/j.vgie.2025.04.006","DOIUrl":"10.1016/j.vgie.2025.04.006","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Candy cane syndrome is a rare adverse event of gastric bypass or gastrectomy, where a blind jejunal pouch fills with food, causing dilation and compression of the efferent limb, leading to obstructive symptoms like vomiting and regurgitation. Surgical resection is curative but technically challenging, and endoscopic treatment using lumen-apposing metal stent (LAMS) insertion has been attempted.</div></div><div><h3>Methods</h3><div>This case describes a retrograde LAMS insertion in a patient with previous total gastrectomy who presented a decade later with dysphagia and food regurgitation. Imaging revealed an enlarged blind jejunal pouch and migration of the esophagojejunostomy anastomosis above the diaphragm and into the thoracic cavity. A tandem endoscopic approach with an ultraslim gastroscope and an echoendoscope was used to place a LAMS from the efferent limb into the blind pouch. The gastroscope is used to assist with instillation of saline and endoscopic visualization of the LAMS in the blind pouch to ensure safe deployment. A retrograde approach from the efferent limb to the blind pouch allows a larger and more stable target for puncture, and a better LAMS axis for effective diversion of food.</div></div><div><h3>Results</h3><div>He gained 9 kg over 4 months after the procedure and was able to tolerate a normal diet. The LAMS was planned for removal after 10 to 12 months to allow longer indwelling time and greater rate of patency.</div></div><div><h3>Conclusions</h3><div>Endoscopic management with EUS-guided LAMS insertion is a promising alternative to surgical resection for candy cane syndrome.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 9","pages":"Pages 479-482"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection for drainage of esophageal abscess with fish bone extraction","authors":"Abel Joseph MD,&nbsp;Linda Nguyen MD,&nbsp;Joo Ha Hwang MD, PhD","doi":"10.1016/j.vgie.2025.04.005","DOIUrl":"10.1016/j.vgie.2025.04.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Foreign body ingestion with submucosal penetration presents a challenging clinical scenario. We present a case of successful endoscopic submucosal dissection (ESD) for removing an embedded fish bone with drainage of an associated submucosal abscess.</div></div><div><h3>Methods</h3><div>A 49-year-old woman presented with odynophagia after fish bone ingestion. Computed tomography scan identified a linear density in the upper esophagus. After an initial negative esophagogastroduodenoscopy, a repeat procedure revealed a submucosal abscess. The ESD technique was used to drain the abscess and retrieve the fish bone.</div></div><div><h3>Results</h3><div>The fish bone was successfully removed using ESD technique without immediate or delayed adverse events. Postprocedure management included antibiotics, proton pump inhibitor therapy, and dietary modification. Follow-up esophagram confirmed absence of fistula or abscess.</div></div><div><h3>Conclusions</h3><div>This case demonstrates the importance of careful endoscopic assessment and the utility of ESD technique in managing superficial esophageal abscesses. ESD is a safe and effective technique for removing embedded esophageal foreign bodies within the submucosa.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 9","pages":"Pages 460-463"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removing inflammatory bowel disease–associated dysplastic lesions with benign negative lift sign with cap-assisted EMR: a video tutorial for practicing gastroenterologists","authors":"Julie N. Murone DO,&nbsp;Brandon Rodgers MD,&nbsp;Matthew T. Moyer MD, FASGE","doi":"10.1016/j.vgie.2025.04.008","DOIUrl":"10.1016/j.vgie.2025.04.008","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Colon polyps associated with long-standing inflammation from inflammatory bowel disease (IBD) are prone to develop submucosal fibrosis. This underlying fibrosis from chronic inflammation can make dysplastic mass lesions difficult to resect. Using a distal cap attachment when performing EMR for removal of these fibrotic and scarred-down lesions can be advantageous.</div></div><div><h3>Methods</h3><div>Three representative cases of dysplastic, IBD-associated, colon mass lesions resected by cap-assisted EMR were selected from a previously reported case series for demonstration purposes. Lesions are first evaluated for malignant features, and if none are present, lifting is attempted but often fails to lift the lesion. The cold or hot snare is placed over the lesion, and suction is used to bring the target tissue through the snare and into the clear distal cap attachment. The snare is blindly closed, suction released, and the amount of tissue captured is evaluated. If appropriate, the snare is slightly lifted away from the wall to limit the amount of thermal exposure to the muscularis propria and then subsequently transects the tissue. This process is completed until the lesion is completely removed. Thermal treatment is performed to the lesion edges and any nodularity.</div></div><div><h3>Results</h3><div>Three cases are presented demonstrating cap-assisted EMR for adherent dysplastic lesions in patients with IBD, with a fourth case included as an example of a type IV muscle injury occurring and treated during cap-assisted EMR.</div></div><div><h3>Conclusions</h3><div>Distal cap-assisted EMR is a safe and effective technique that can be used in patients with IBD with tacked-down, fibrotic, dysplastic lesions attributable to submucosal fibrosis. However, it is important for endoscopists to be comfortable with lesion recognition as well as recognizing and managing related muscle injuries with a low-threshold for closure of the resection site.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 9","pages":"Pages 499-503"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of gel immersion endoscopy for endoscopic resection in stomachs with residue","authors":"Hiroki Hayashi MD ,&nbsp;Yuji Ino MD ,&nbsp;Chihiro Iwashita MD, PhD ,&nbsp;Mio Sakaguchi MD ,&nbsp;Yoshimasa Miura MD, PhD ,&nbsp;Edward J. Despott MD, FRCP, FEBGH, FASGE, FJGES, FESGE, MD (Res) ,&nbsp;Tomonori Yano MD, PhD ,&nbsp;Hironori Yamamoto MD, PhD","doi":"10.1016/j.vgie.2025.03.040","DOIUrl":"10.1016/j.vgie.2025.03.040","url":null,"abstract":"<div><h3>Background and Aims</h3><div>EMR and endoscopic submucosal dissection are widely used for treating intramucosal gastric neoplasms. However, securing a clear visual field in a stomach with residue is challenging. In this article, we present 2 cases in which tumors were endoscopically resected by securing the visual field using the gel immersion method in remnant stomachs after proximal gastrectomy with residue.</div></div><div><h3>Methods</h3><div>The gel immersion method is a technique in which a transparent, viscous gel is injected into the lumen to secure the visual field. The viscous gel displaces blood and residue, allowing for a clear view. Therefore, we could perform efficient endoscopic procedures calmly. We also used the dedicated valve to add the gel while we inserted devices through its accessory channel.</div></div><div><h3>Results</h3><div>In both cases, the gel immersion method successfully displaced food residue, providing a clear visual field and enabling precise mucosal incision and resection. In the first case, we achieved en bloc resection in a 71-year-old man with a 5-mm adenoma by using gel immersion EMR. In the second case, a 74-year-old man with a 12-mm intramucosal adenocarcinoma underwent gel immersion endoscopic submucosal dissection, which facilitated an accurate incision line and effective coagulation. Both patients had negative resection margins, and no adverse events were observed.</div></div><div><h3>Conclusions</h3><div>The gel immersion method effectively improved visualization in a stomach with residue, enhancing the safety and precision of endoscopic resection.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 9","pages":"Pages 469-474"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture traction—assisted bearclaw fistula closure: a case series describing a novel endoscopic technique for fistula closure","authors":"Joelle Sleiman MD ,&nbsp;Mohammad Abureesh MD ,&nbsp;Vishnu Charan Suresh Kumar MD ,&nbsp;Ahmed Elfiky MD ,&nbsp;Jean M. Chalhoub MD ,&nbsp;Sherif Andrawes MD ,&nbsp;Youssef El Douaihy MD","doi":"10.1016/j.vgie.2025.04.003","DOIUrl":"10.1016/j.vgie.2025.04.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic therapies are currently the mainstay of treatment for GI fistulas. However, some GI fistulas are hard to treat as the result of the tissue's friability and large size defect. This case series describes a novel technique for managing hard-to-treat fistulas.</div></div><div><h3>Methods</h3><div>Using an endosuturing device, we strategically obtain full-thickness bites at various points around the fistula opening. After each bite, the anchor is released, and a new suture thread is loaded into the suturing device for another bite at a different point. These sutures are intentionally left untightened, remaining loose within the GI tract. Subsequently, the scope is withdrawn, leaving the sutures extending outside the patient. In using a dual-channel scope, we mount an over-the-scope clip on the scope, and the suture threads are captured through one of the scope channels using a snare. The endoscope is reintroduced. Traction is then applied to the suture threads, allowing healthy tissue to be drawn outside the fistula, forming a flap. Once enough tissue is pulled inside the over-the-scope cap, the clip is deployed, creating an occlusive patch and effectively sealing the fistulous tract.</div></div><div><h3>Results</h3><div>We present 3 cases of GI fistulas that failed to close using traditional endoscopic techniques. The first case is that of a 78-year-old man with a history of bladder cancer treated with radical cystectomy and neobladder construction, as well as a long history of ulcerative colitis resulting in a rectovesicular fistula. The second case is of a 68-year-old man with a history of gastric cancer treated with partial gastrectomy and gastrojejunostomy complicated by jejunocolonic fistula formation. The third patient is a 30-year-old man with a history of cerebral palsy who relies on enteral feeding via jejunostomy, with gastrocutaneous fistula formation at the previous gastrostomy tube site.</div></div><div><h3>Conclusions</h3><div>We presented 3 successful applications of this novel technique, each with a 9- to 13-month follow-up showing no recurrence or adverse events. This technique offers a promising solution for challenging fistulas that resist closure with standard procedures.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 9","pages":"Pages 487-492"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel anatomically guided strategy for evaluation of sufficient myotomy during peroral endoscopic myotomy in patients with achalasia","authors":"Ahmad Madkour MD ,&nbsp;Amr Elfouly MD ,&nbsp;Osama Elnahas MD ,&nbsp;Ningli Chai MD ,&nbsp;Muhammad Elzahaby MD ,&nbsp;Hosam Hamed MD ,&nbsp;Hassan Atalla MD","doi":"10.1016/j.vgie.2025.03.039","DOIUrl":"10.1016/j.vgie.2025.03.039","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Peroral endoscopic myotomy (POEM) necessitates proper orientation of the anatomical landmarks throughout the whole procedure to assess the myotomy, which is the main target of POEM. Insufficient myotomy renders the procedure ineffective and may lead to nonresponse or recurrence, although longer myotomy may increase the risk of reflux. The current conventional methods for esophagogastric junction (EGJ) detection are often operator-dependent, time-consuming, and have questionable accuracy. We aimed to provide a novel anatomically based approach for more precise tailoring of myotomy.</div></div><div><h3>Methods</h3><div>It depends on the clear demarcation of the meeting of 3 landmarks at the EGJ (the EGJ triad): esophageal adventitia, diaphragmatic crura and perigastric peritoneum. Once this triad is seen, after commencing the full-thickness myotomy procedure, then an optimum length of myotomy should be achieved, and no further myotomy is needed.</div></div><div><h3>Results</h3><div>The technique is considered a feasible, effective, and reproducible method that might be attractive for experienced endoscopists practicing POEM. This method is time-preserving and reproducible and enhances the endoscopist’s capabilities in dealing with problematic cases through increasing his or her familiarity with the surgical anatomy at the EGJ and at the same time avoids procedure failure or recurrence of symptoms and decreases the risk of reflux.</div></div><div><h3>Conclusions</h3><div>This approach provides a potential supportive method for achieving an optimum myotomy during POEM procedures, ensuring effective treatment and avoiding POEM-induced reflux.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 9","pages":"Pages 452-454"},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastroplasty with endoscopic myotomy as a revision procedure after weight regain after remote endoscopic sleeve gastroplasty","authors":"Kartik Sampath MD ,&nbsp;Kamal Hassan MD ,&nbsp;Jeong Hoon Kim MD ,&nbsp;Jade Wang MD ,&nbsp;Vladislav Fomin MD,&nbsp;Anam Rizvi MD,&nbsp;Reem Z. Sharaiha MD","doi":"10.1016/j.vgie.2025.03.038","DOIUrl":"10.1016/j.vgie.2025.03.038","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Suture dehiscence and gastric sleeve dilation can cause post–endoscopic sleeve gastroplasty (ESG) weight regain. To our knowledge, gastroplasty with endoscopic myotomy (GEM) as a post-ESG revision technique has not been previously reported. We present a case of GEM successfully used after a primary ESG as a revision procedure.</div></div><div><h3>Methods</h3><div>A 52-year-old man had a weight of 111 kg in 2016 before ESG. Postprocedure, his weight reached 95 kg. However, he returned in 2023 with weight regain to 121 kg. GEM was decided after multidisciplinary discussion. Previous suture sites were appreciated. An antral myotomy was started with a bleb injected 8 cm proximal to the pylorus. The submucosal tunnel was entered by hybrid knife incision and dissected 2 cm before the pylorus. A partial full-thickness myotomy was performed with lysis of significant submucosal fibrosis. Gastroplasty was performed, and 8 suture bites were placed in a running modified “U” pattern to decrease gastric volume.</div></div><div><h3>Results</h3><div>There were no intraprocedure adverse events. At 3-month follow-up, the patient had lost 11 kg, and at 1-year follow-up, he had lost 20 kg.</div></div><div><h3>Conclusions</h3><div>To our knowledge, GEM as a post-ESG revision has not been previously reported. Our case suggests that a post-ESG revision GEM with a modified “U” suturing pattern is feasible.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 398-401"},"PeriodicalIF":0.0,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection in the management of bleeding duodenal tumors refractory to conventional therapy","authors":"Daryl Ramai MD, MPH, MSc,&nbsp;Abdulrahman Qatomah MBBS,&nbsp;Marvin Ryou MD,&nbsp;Christopher C. Thompson MD,&nbsp;Hiroyuki Aihara MD, PhD","doi":"10.1016/j.vgie.2025.03.036","DOIUrl":"10.1016/j.vgie.2025.03.036","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Although isolated hamartomas are rare, they can cause bleeding that is refractory to medical treatment. Management strategies depend on factors such as tumor location, size, and bleeding intensity.</div></div><div><h3>Methods</h3><div>A 94-year-old woman experienced melena and a significant decrease in hemoglobin from 13 g/dL to 7 g/dL. An EGD revealed a large, bleeding pedunculated tumor in the duodenum. Previous interventions, including epinephrine injection and EMR, failed, necessitating multiple blood transfusions. After multidisciplinary consultation, endoscopic submucosal dissection was undertaken.</div></div><div><h3>Results</h3><div>En bloc resection of the duodenal lesion was performed successfully. The specimen was segmented and removed without causing any trauma to the duodenal wall.</div></div><div><h3>Conclusions</h3><div>Hamartomas in the upper GI tract, particularly in the stomach or duodenum, pose a greater bleeding risk. Endoscopic submucosal dissection effectively removes large duodenal tumors, especially when EMR is unfeasible. Segmenting the specimen during retrieval minimizes trauma to surrounding tissue, preserving duodenal integrity.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 415-418"},"PeriodicalIF":0.0,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic full-thickness resection of a duodenal gastrointestinal stromal tumor","authors":"Jeong Hoon Kim MD,&nbsp;Jade Wang MD,&nbsp;Patrick Magahis BA,&nbsp;Adeyinka Adejumo MD,&nbsp;Mark Hanscom MD,&nbsp;David Carr-Locke MD,&nbsp;Reem Sharaiha MD,&nbsp;Kartik Sampath MD","doi":"10.1016/j.vgie.2025.04.001","DOIUrl":"10.1016/j.vgie.2025.04.001","url":null,"abstract":"<div><h3>Background and Aim</h3><div>There is limited literature regarding endoscopic removal of gastrointestinal stromal tumors (GISTs) located in the duodenum. We present successful endoscopic submucosal dissection and exposed full-thickness resection (FTR) of an incidentally discovered duodenal GIST in an asymptomatic 65-year-old man.</div></div><div><h3>Methods</h3><div>The lesion was 1.4 cm and well-defined, primarily located in the submucosal layer of the posterior D2 duodenal wall and the level of the major papilla around 2 cm distal to the ampulla. Transverse mucosotomy was made followed by submucosal dissection. An IT2 knife with a protected tip was used for the majority of resection to preserve the lesion’s capsular layer. Methodical dissection was performed until the lesion was removed en bloc. Endoscopic suturing closed the FTR defect with a single running suture. An exposed aspect of the medial mucosal resection site was reinforced with an additional interrupted suture.</div></div><div><h3>Results</h3><div>Postclosure contrast duodenogram was negative for leak. The patient was monitored for 36 hours inpatient without adverse events. Final pathology confirmed complete en bloc resection of a low-grade GIST with a preserved capsule.</div></div><div><h3>Conclusion</h3><div>Endoscopic submucosal dissection/exposed FTR can be an effective, minimally invasive method of resecting duodenal GISTs. In addition, endoscopic suturing is a viable method of resection defect closure in the duodenum.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 419-421"},"PeriodicalIF":0.0,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential for remote hands-on training system for colorectal endoscopic submucosal dissection","authors":"Kohei Ono MD ,&nbsp;Ken Ohata MD, PhD ,&nbsp;Daisuke Ide MD, PhD ,&nbsp;Akiko Ohno MD, PhD ,&nbsp;Takashi Muramoto MD, PhD ,&nbsp;Yosuke Tsuji MD, PhD ,&nbsp;Hideyuki Chiba MD, PhD ,&nbsp;Hiroaki Kato LLB","doi":"10.1016/j.vgie.2025.03.037","DOIUrl":"10.1016/j.vgie.2025.03.037","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Hands-on training plays a crucial role in the acquisition of endoscopic skills; however, its transition to an online format has been considered challenging due to the inherently tactile and direct nature of instruction. Since 2020, we have conducted an online colorectal endoscopic submucosal dissection (ESD) training course, holding 9 sessions and training a total of 75 participants. The aim of this study is to evaluate the effectiveness of our remote hands-on training program for colorectal ESD.</div></div><div><h3>Methods</h3><div>Using a wired 50 Mbps connection, we linked a central facility to 3 remote sites across Japan. A 4-screen Picture-in-Picture (PinP) video integrating hand, scope, posture, and endoscopic views was streamed for real-time demonstration. Each participant underwent a structured 70-minute training session consisting of an initial and final time trial using the Scope handling Training (ST) kit, endoscope handling practice, and hands-on ESD training with an artificial model. During the remote hands-on phase, trainees performed procedures while receiving real-time instruction from experts via a Picture-in-Picture video system, which displayed both the endoscopic view and hand movements. There were no detectable delays in audio or video communication, enabling seamless 2-way interaction.</div></div><div><h3>Results</h3><div>The results of the ST kit time trials conducted before and after the training showed a significant improvement in speed after the training (from 89.3 seconds before training to 49.4 seconds after training). Additionally, a questionnaire survey conducted among participants revealed that 94% expressed a desire to participate in similar remote training sessions in the future.</div></div><div><h3>Conclusions</h3><div>Colorectal ESD, which involves delicate and highly intricate techniques, is challenging to teach even in face-to-face settings. However, we were able to provide high-quality instruction in this program. This method provides training opportunities for physicians in remote areas, reducing the burden of time, travel, and costs, and has the potential to become a promising educational tool for the future.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 428-433"},"PeriodicalIF":0.0,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}