Sleeve Esophageal Endoscopic Mucosectomy “SEEM”
Presented by Ahmed Sharata, MD, at the SAGES 2014 Meeting; Panel – Concurrent Session SS6 V025
Ahmed Sharata, MD, Christy M Dunst, MD, Radu Pescarus, MD, Eran Shlomovitz, MD, Ashwin Kurian, MD, Kevin M Reavis, MD, Lee L Swanstrom, MD; Providence Portland Medical Center, The Oregon Clinic
Points of interest:
early esophageal cancer treatment–12 sec
example of long segment Barrett’s esophagus–1:17
SEEM technique–2:00
raising the wheal–2:18
posterior proximal mucosotomy–3:00
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Keyword(s): 12 cm segment, 5 weeks post SEEM, anterior sub-mucosal tunnel, anterior tunneling, anterior wall, Barretts esophagus, biologic matrix, cauterized, circular muscle, circumferential endoscopic resection, circumferential mucosectomy, circumferential submucosal tunnel, completely expand the stent, contraindication, correct position, countertension, cryofrequency ablation, distal (GEJ) circumferential mucosectomy, distal circumferential mucosectomy, distal esophageal stricture, early esophageal cancer treatment, easily deployed, elongation and collapse of stent, endoscope, endoscopic channel, endoscopic mucosal resection, esophageal adenocarcinoma, esophageal lumen post-SEEM, esophageal mucosa, esophageal mucosa is diffusely irregular, esophageal preserving techniques, esophageal radiofrequency ablation, esophagectomy, expanding stent, FSIE, fully covered stent, HGD, highly effective and safe, highly morbid, IMC, incidence, invasive, lack of specimen for pathology, less invasive approach, less morbidity, limited to smaller lesions, long segment Barretts esophagus, lumen after stent removal, merging the tunnels, mid-esophagus, multifocal intramucosal carcinoma, multifocal nodular intra-mucosal cancer, no evidence of obstruction, no extravasation, nodularity, novel approach to stent deployment, over the scope technique, over-scope stent deployment, piecemeal dissection, possible complication, post stent removal, posterior proximal mucosotomy, posterior tunneling, posterior wall, preparing over-scope stent, proximal and distal end of stent, proximal anterior mucosotomy, proximal circumferential mucosectomy, proximal posterior mucosotomy, pursestring suture, raising the mucosal wheal, release distal part of the specimen, removal of large lesion, repeat procedures typical, retroflex view of GEJ, SEEM, SEEM technique, shortening and widening of the stent, specimen extraction, stricture prevention strategies, stricture site, stricturing, sub-mucosal tissue bridge, submucosal invasion, substantial incorporation into the esophageal muscular wall, systemic steroids, tension, traditional approach