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Surgical Smoke Nearly Killed Me - Subscribe to Outpatient Surgery Magazine - February 2018

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 97 of 128

ically, takes anywhere from 90 minutes to 2 hours and can be done in an outpatient procedure, with patients fully recovered in 1 to 3 days. Like other endoscopic weight-loss procedures, gastroplasty reduces weight loss by reducing the available space in the stomach. "It creates a lower ability to accommodate food," says Dr. Gross. Studies showed that patients reported 30% excess weight loss after the procedure. 3. Easily remove dangerous tissue Gastroenterologists have often used endoscopic mucosal resection (EMR) to tackle and remove gastrointestinal lesions and to manage early gastric cancer. But a new procedure has been increasing in pop- ularity over the past few years, endoscopic submucosal dissection (ESD), which can help resect larger and deeper lesions. ESD removes flat, raised polyps and mucosal neoplastic lesions in the stomach, which can't be taken out by the average biopsy forceps, says Dr. Gross. ESD also helps resect small bumps that are not on the surface of the mucosa, says Dr. Sundararajan. The doctor marks the perimeter of the lesion with a dye before injecting a lifting fluid underneath the lesion, into the submucosa to elevate it, says Dr. Gross. You can use several different substances for the lifting fluid, but many doctors use 0.4% hydroxypropyl methylcellu- lose because it's relatively inexpensive and effective, according to a 2014 ESD analysis in the Gastrointestinal Endoscopy Journal. After injecting the lifting fluid, the doctor will use a special electro- surgery knife — the knives can measure anywhere from 2 mm to 4.5 mm in length — to cut around the circumference of the lesion before "tunneling under," cutting into the submucosa and resecting the lesion, says Dr. Gross. "You have to lift it up and almost unearth it in a sense," says Dr. Sundararajan. The procedure helps your doctor resect a larger lesion — one that otherwise might need to be taken out via 9 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R U Y 2 0 1 8

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