Table Of ContentGuide to Complex
Interventional
Endoscopic Procedures
Kelly Esponda
Stephanie Shea
Cristina Demone
Editors
123
Guide to Complex Interventional
Endoscopic Procedures
Kelly Esponda • Stephanie Shea
Cristina Demone
Editors
Guide to Complex
Interventional Endoscopic
Procedures
Editors
Kelly Esponda Stephanie Shea
Robert Wood Johnson University Hospital Robert Wood Johnson University Hospital
New Brunswick, NJ New Brunswick, NJ
USA USA
Cristina Demone
Robert Wood Johnson University Hospital
New Brunswick, NJ
USA
ISBN 978-3-030-80948-5 ISBN 978-3-030-80949-2 (eBook)
https://doi.org/10.1007/978-3-030-80949-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
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This book is dedicated to all the people that
have contributed to our knowledge and
supported us on this journey. First and
foremost to the nursing and Certified
Endoscopy tech staff at Robert Wood
Johnson University Hospital, without you we
would have not been able to build such a
successful interventional endoscopy
program. Your thirst for knowledge inspired
this book. Thank you to Amy Jablonski who
led the development of the interventional
endoscopy nursing program. Your hard work
and dedication to this field is an inspiration
to us all. Thank you to the interventional
endoscopy physicians who push us each day
to expand our knowledge and create an
environment of learning.
This is what we do!
About the Book
Interventional endoscopy offers patients a safer and more cost-effective treatment
option. These procedures are new and on the rise. This manual will walk you through
the setup, supplies, nursing considerations, troubleshooting, and steps to success-
fully assist during these cutting-edge interventional GI procedures that are being
performed. The book will contribute, as the first of its kind, by helping endoscopic
surgical centers to prepare for and train staff in order to offer these procedures to
their patients. It will go into detail on each procedure about what the procedure is
and why a patient would benefit from it. Pictures will be included to demonstrate
what the procedure will look like. It is a detailed step-by-step manual including
photos on each case describing the setup, pre-, intra-, and post-procedure care and
responsibilities. This book includes a full range of highly advanced procedures that
are on the forefront of medicine. It will help nurses and technicians who are being
trained to assist in these new, complex procedures by following a step-by-step guide.
Abbreviations and Endoscopy Terminology
Double Dip Patient is Scheduled for Both Colonoscopy and Endoscopy
Duey Short for Duodenum
EFTR Endoscopic Full-Thickness Resection
EGD Esophagogastroduodenoscopy
EGDE EUS-Directed Transgastric ERCP
EMR Endoscopic Mucosal Resection
ERCP Endoscopic Retrograde Cholangio-pancreatography
ESD Endoscopic Submucosal Dissection
ESG Endoscopic Sleeve Gastroplasty
G POEM Gastric Myotomy
GEJ Gastric Esophageal Junction
POEM Per Oral Endoscopic Myotomy
SCD Sequential Compression Device
STER Submucosal Tunneling of Endoscopic Resection
TIF Transoral Incisionless Fundoplication
UES Upper Esophageal Sphincter
Z POEM Zenker’s Diverticulum Myotomy
vii
Contents
1 Endoscopic Resections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Cristina Demone, Kelly Esponda, and Stephanie Shea
2 Peroral Endoscopic Myotomy (POEM) . . . . . . . . . . . . . . . . . . . . . . . . . 35
Cristina Demone, Kelly Esponda, and Stephanie Shea
3 Transoral Incisionless Fundoplication (TIF) . . . . . . . . . . . . . . . . . . . . . 49
Cristina Demone, Kelly Esponda, and Stephanie Shea
4 Endoscopic Retrograde Cholangiopancreatography . . . . . . . . . . . . . . . 59
Cristina Demone, Kelly Esponda, and Stephanie Shea
5 Endoscopic Ultrasound Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Cristina Demone, Kelly Esponda, and Stephanie Shea
6 Pancreatic Fluid Collection Procedures . . . . . . . . . . . . . . . . . . . . . . . . . 107
Cristina Demone
7 Endo-Bariatric Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Cristina Demone, Kelly Esponda, and Stephanie Shea
8 Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Cristina Demone, Kelly Esponda, Stephanie Shea, Michel Kahaleh,
Amy Tyberg, Avik Sarkar, and Haroon Shahid
ix
About the Editors
Kelly Esponda is a Certified Senior Endoscopy Technician with over 15 years of
OR and Endoscopy experience. A graduate of NYU Associates Surgical Technologist
program, she worked in the operating room at Memorial Sloan Kettering SDH cen-
ter until she saw the light of the Endoscope. Truly fascinated by an ever-growing
specialty she was fortunate enough to find herself working alongside Dr. Michel
Kahaleh at Weill Cornell NY Presbyterian Hospital’s Endoscopy Suite where she
quickly became part of his team and essentially his “right” hand. She has worked
with Dr. Kahaleh for the past 10 years, following him to Robert Wood Johnson
University Hospital in New Brunswick, NJ. She resides with her husband and chil-
dren in Manhattan, NY. Kelly truly loves what she does and it was evident to her
colleagues especially Dr. Kahaleh as he invited her to help train and educate other
endoscopists and their staff nationally and internationally. Together they have been
invited to proctor and assist at Kaiser Permanente West LA Hospital. Kelly was a
professor in third space and POEM courses held in Posadas, Argentina, where she
taught and trained endoscopy staff. She was named Director of the Nurses and
Technician course held in Reynosa, Mexico, leading to her getting invited to La Paz,
Bolivia, where she helped to build their endoscopic myotomy program. In addition,
she had the honor of traveling to Seoul, Korea, where she trained the staff on
Pancreatic and Biliary Ablation.
Kelly works tirelessly to train and orient new staff all over the world on these
cutting-edge procedures. With the growing number of physicians performing these
procedures and the need for more education, Kelly cannot be everywhere. This book
is literally her blood, sweat, and tears of working with a world-renowned endoscopist.
Stephanie Shea is a Registered Nurse with over 18 years of experience. She cur-
rently resides in New Jersey with her family.
Stephanie is the Director of Operations over the bustling state-of-the-art
Endoscopy suite at Robert Wood Johnson University Hospital. In her current posi-
tion she is responsible for leading multiple health care disciplines including nurses,
physicians, APNs, PAs, radiology technicians, and nursing assistants. She works
with other hospital leadership to develop strategic plans to operate and grow the
Endoscopy suite and its services. She collaborates with physicians on a daily basis
to provide support and resources to care for patients. She also fosters the units’
xi
xii About the Editors
growth and development by bringing in new medical devices and using evidence-
based practice to successfully implement change in a rapidly growing unit.
Cristina Demone is a Registered Nurse with a Bachelor of Science from Rutgers
University and Seton Hall School of Nursing. She has 15 years of hands on experi-
ence, most being in the Emergency Department. After 15 years of hospital nursing
experience, an opportunity presented itself to work in the Endoscopy Department.
Initially she was hesitant at first, due to what felt like overwhelming training and
another language altogether. Never one to shy away from a challenge, she tackled
it and ended up loving it.
She also has extensive training in Cardiology and Interventional Radiology.
Cristina is certified in Advanced Cardiac Life Support, Pediatric Advanced Life
Support, and Emergency Nursing. Cristina currently works as the coordinator in a
state-of-the-art Interventional Endoscopy Department. She is pursuing a master’s
degree in nursing to become an adult and gerontology acute care nurse practitioner.
Cristina has a zest for life and is passionate about being a nurse.
Contributors
Cristina Demone Robert Wood Johnson University Hospital, New
Brunswick, NJ, USA
Kelly Esponda Robert Wood Johnson University Hospital, New Brunswick,
NJ, USA
Michel Kahaleh, MD Advanced Endoscopy Research Program at the Department
of Medicine, Robert Wood Johnson Medical School, Rutgers, The State University
of New Jersey, New Brunswick, NJ, USA
Avik Sarkar Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
Haroon Shahid, MD Rutgers-Robert Wood Johnson Medical School, New
Brunswick, NJ, USA
Stephanie Shea Robert Wood Johnson University Hospital, New
Brunswick, NJ, USA
Amy Tyberg Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
Endoscopic Resections 1
Cristina Demone, Kelly Esponda, and Stephanie Shea
1.1 EMR (Endoscopic Mucosal Resection)
Endoscopic mucosal resection (EMR) (Fig. 1.1) is a procedure that is used specifi-
cally to remove lesions located within the gastrointestinal (GI) tract but does NOT
affect areas beyond the outer walls of the GI tract or GI lumen (interior area of a
tubular organ which is surrounded by body tissue).
The procedure involved injecting a solution that aims to strengthen and thicken a
section of the GI tract, just beneath the location of the lesion. This will create a fluid
cushion that allows the lesion to be safely removed. The entire procedure is mini-
mally invasive, making use of an endoscope for its entirety.
This procedure can be safely performed on lesions located within the esophagus,
stomach, small intestine, and large intestine.
Medications
• Protonix 40 mg IV Push—only given for esophageal procedures
• Methylene Blue 2 mL diluted in a 1 L bag of 0.9% normal saline (NS) (Fig. 1.2)
Esophageal and Colonic EMR Set-up and Supplies
• Adult EGD or colonic scope
• Electrosurgical generator with pure cut/sinusoidal waveform (such as
ERBE system)
• CO insufflator
2
• Duette Kit includes bander with bands and snare (Fig. 1.3)
• Injection needle with lifting agent (Figs. 1.4 and 1.5)
• APC—Straight fire Grounding Pad
C. Demone · K. Esponda · S. Shea (*)
Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
© The Author(s), under exclusive license to Springer Nature 1
Switzerland AG 2021
K. Esponda et al. (eds.), Guide to Complex Interventional Endoscopic
Procedures, https://doi.org/10.1007/978-3-030-80949-2_1
