Endoscopic innovations in gastric and pyloric disease

Abstract

Endoluminal surgery has innovated the management of foregut disorders including gastric motility disorders such as gastroparesis, upper gastrointestinal (GI) neoplasms including early-stage gastric cancer, gastric outlet obstruction, and management of post-operative foregut complications. Foregut pathologies that would have otherwise required abdominal incisions can now be successfully managed in the most minimally invasive available fashion. Intramural intervention, such as that used for per-oral pyloromyotomy (POP) which will be described here, has revolutionized the treatment of motility disorders of the foregut. Many aspects of the techniques described in this chapter share and build off of one another and several of the endoscopic instruments utilized are also shared across procedures. This is one of the many reasons endoluminal surgery has blossomed over the last two decades. To truly flourish as a foregut surgeon is to have the capability to perform the open, laparoscopic and the existing and future endoscopic alternatives of procedures of this specialty, as well as to manage complications in an endoscopic fashion when possible. Now, there are fellowships dedicated to advanced surgical endoscopy and the field is continuously expanding with new innovations and techniques. This review will focus on the current endoscopic management of gastroparesis, endoscopic submucosal dissection for gastric masses, and post-operative management of foregut surgery complications including strictures and stenosis. It is exciting, and without doubt, that in a decade many of these procedures will have evolved beyond current recognition.