Lack of proper reimbursement is hampering adoption of minimally invasive gastrointestinal endoscopy in North America

Endoscopic submucosal dissection(ESD)and related procedures are minimally invasive and cost-effective alternates to surgery.However,there is no approved or listed current procedural terminology(CPT)for ESD.We aimed to review the current reimbursement process hurdles for ESD procedures in private practice model in United States.We reviewed the data of two advanced endoscopists(one in New York and other in Pennsylvania State)performing ESD in their private practice set-ups.We found the reimbursement process was complex,with number of refusals varied from 0-9 for ESD procedures.It was not paid at all in 8.3%of cases by the medical insurance.Endoscopic mucosal resection,which is considered inferior as compared to ESD,but has a listed CPT,was denied in only 0.83%cases.Our data highlights the billing hurdles by the endoscopists to adopt ESD-related procedures in private practice model.

Application of Endoscopic Vein Harvesting in Obese Patients Undergoing Coronary Artery Bypass Grafting

This study aims to evaluate the clinical outcomes of endoscopic vein harvesting （EVH） for coronary artery bypass grafting （CABG） in obese patients. Totally, 153 obese patients who underwent EVH （n=81） or standard bridging technique （SBT, n=72） in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups （P〉0.05）. There were no statistical differences in total operation time （226±28 min vs. 224±30 min, P〉0.05）, number of damaged vessels （0.12±0.05 vs. 0.16±0.06, P〉0.05） and short medium-term outcomes including revascularization rate （1.25% vs. 2.78%, P〉0.05）, vessel dysfunction rate （11.25% vs. 11.11%, P〉0.05） and mortality （0.00% vs. 0.00%, P〉0.05）. Use of EVH was associated with significant reduction of total harvesting time （41±6 min vs. 63±11 min, P〈0.05）, incision length （4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05） and postoperative lower extremity complications （P〈0.05）. EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.

Endoscopic treatment of urothelial encrusted pyelo-ureteritis disease:A case series

BACKGROUND Urothelial encrusted pyelo-ureteritis disease is an infrequent condition and there is no unified surgical treatment and reference standard to consult.We have used a minimally invasive endoscopic method to treat three such cases,which yielded excellent results.CASE SUMMARY The first case was a 45-year-old man who had unilateral ureteropelvic junction(UPJ)atresia and contralateral stenosis and was treated by double endoscopic surgery using an anterograde percutaneous nephroscope coupled with a rigid retrograde ureteroscope.The second case was a 12-year-old boy who received a percutaneous nephroscopy on one side and a percutaneous nephroscopy with a rigid ureteroscope on the other side due to the presence of bilateral UPJ stenosis.The third case was a 32-year-old woman with bilateral lower ureteral stricture treated using a rigid retrograde ureteroscope.Endoscopic surgeries were successfully performed on all the three patients.Varying degrees of encrustation and erosion of the urothelium were observed during the operation.The calcified layer composition analysis showed magnesium ammonium phosphate or carbonate apatite.Two patients achieved a good prognosis.CONCLUSION Minimally invasive endoscopic treatment for urothelial encrusted pyelo-ureteritis disease can yield better results.