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1. Introduction to ESD & POEM

History and Evolution of ESD & POEM

• Overview of development and significance of ESD & POEM

• Comparative analysis with other endoscopic procedures

Indications and Contraindications

• Clinical indications for ESD and POEM

• Patient selection criteria and risk assessment

• Contraindications and managing high-risk patients

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2. Incorporating ESD & POEM into your clinical practice algorithm and overall Program

From EMR to ESD 

• Having both options in your program

• Maintaining proficiency

• Division of Labour

• Developing a referral base

POEM: E & G 

• Developing a program 

• Identifying a motility partner 

• Consider a “tumor board” type approach (with surgical colleagues)

• Following patients

Diverticulotomy

• Identifying patients

• Advertising the program

• Developing a referral base (PCPs to ENTs)

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3. Tools and Equipment

• Detailed overview of essential tools and equipment for ESD and POEM

• Proper handling and maintenance of instruments

• What do I need in my toolbox? (cost of items, must-haves, options)

• Innovations and emerging technologies in therapeutic endoscopy

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4. Electrosurgery

• Principles

• Waveforms

• Generators

• Translating current to tools and clinical practice

• Precautions

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5. Planning for ESD 

• Comprehensive pre-procedure evaluation (EUS, cross-sectional imaging)

• Patient preparation and positioning considering ESD site

• Anticoagulation/antibiotics

• Resection strategies

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6. ESD Technique Mastery

• Step-by-step guide to performing ESD

• Techniques for mucosal incision and submucosal dissection

• Managing complications during ESD (subcategories: esophageal, gastric, duodenal, rectal)

 

7. Planning for POEM

Considerations and approaches

• Prior interventions? 

• Endoflip/Manometry review

• Measurements

• Mucosa healthy?

• Antibiotics

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8. POEM Technique Mastery

• Step-by-step guide to performing POEM (subcategories E, G)

• Techniques for submucosal tunneling and myotomy

• Managing complications during POEM (subcategories: E, G)

 

9. Planning for Diverticulotomy

• Anticoagulation/antibiotics

• ET tube

• Support

• Post-procedure monitoring and esophagram

 

10. Diverticulotomy Technique Mastery

Anatomy and Technique

• Traditional Septotomy

• Z-POEM

• Modified Z-POEM

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11. Economics of ESD and POEM

• Cost analysis and budgeting for procedures

• Insurance and reimbursement considerations

• Economic impact and value proposition for healthcare facilities

• How to bill as an institution

• What to ask for? (wRVU)

 

12. Building and Managing an ESD/POEM Program

• Establishing a therapeutic endoscopy program

• Training for support staff

• Marketing and outreach to referring physicians