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Non-extension sign: Sign of SM2 extension ( depth of 500 μM or more) The SM2-invasive area can be seen as a trapezoid elevation with elevation of the surrounding mucosa due to localized thickening and hardening associated with submucosal invasion by cancer cells

🐳Whale tail sign 💡The division of the celiac artery into the splenic and hepatic artery

CA 19-9 🔑 Facts ~10% of people don’t produce (Lewis antigen -) →<2U/mL ⅓ pancr cancer pts have normal levels (≤37 U/mL) Uses: Detect occult metastases; Assess risk; treatment response Not specific! Can be elevated in benign conditions (e.g., biliary obstruction, pancreatitis)

💡Preoperative biliary drainage in Pancreatic Cancer 🟨bilirubin level is >14mg/dL 💉jaundice pts planned to receive neoadjuvant treatment 🔪surgery will be delayed for longer than 2 weeks 🦠cholangitis

I rated Lahn Mah (2024) 10/10 #IMDb imdb.com/title/tt313926…

I rated The Guilty (2021) 6/10 #IMDb imdb.com/title/tt9421570

💡Important luminal landmarks in POEM. a=spine b=aortic arch c=trachea d=left main bronchus e=GEJ in retroflexion f=GEJ in forward view. 📗Nature Reviews Gastroenterology & Hepatology Robert Bechara

Several landmarks are currently used to identify the correct localization of the cardia during POEM transillumination POEM auxiliary technique with a second ultra-slim gastro scope inserted transnasally, advanced into the stomach and retroflexed. by Francisco Baldaque-Silva

Two penetrated vessels on gastric cardia 1, Oblique muscle 2, circular muscle 3, 1st penetrated vessel; 4, 2nd penetrated vessel (c) Final position by double scope endoscopy 💡TPVs appears to be a simple and reliable indicator to determine the appropriate distal end of myotomy.

Type I: duodenal wall injury from scope angulation or forceful withdrawal during stone extraction Type II: perforation from large balloon sphincteroplasty or deep sphincterotomy Type III: bile duct injury from wire/basket, seen after contrast injection Stapfer M, Ann Surg 2000

Transoral Outlet Reduction (TORe): Indications and Contraindications

Diagnostic algorithm for suspected eCCA. ERCP + brush cytology & endobiliary forceps biopsy is suggested as the 1ry tool. Overall sensitivity of brush is: 43% Combined with forceps: 66% 👉Cholangioscopy-directed biopsies is suggested when: i) previous ERCP sampling was negative

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