From
Dr. Jeffrey Ponsky
SAGES/ALACE Symposium: Integrating New Technologies, Old Tricks, and Operative Approaches
With Dr. Jeffrey Ponsky
Part of
Achalasia 9 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Podcast
Gastroesophageal Reflux Disease
Jeffrey Ponsky · 33 min · Published Jun 2016
Podcast
Gastroesopheal Reflux Disease
33 min · Published Dec 2016
Video
How effective is POEM in children?
Published Oct 2019
Video
Update Course 2023 - Updates in Pediatric Achalasia Management
26 min · Published Aug 2023
Video
Meet the Master: Jeffrey L. Ponsky, MD, FACS
Jeffrey Ponsky · 65 min · Published May 2019
Video
Endoscopy and Surgery
Jeffrey Ponsky · 11 min · Published Mar 2021
Podcast
The invention of the PEG tube with Dr. Jeffrey Ponsky
Jeffrey Ponsky · 33 min · Published Jul 2026
Podcast
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
Jeffrey Ponsky · 3 min · Published Aug 2025
Video
ACS Icons in Surgery | Jeffrey L. Ponsky, MD, FACS
Jeffrey Ponsky · 20 min · Published Jul 2024
Video
SAGES Stories Episode 11 – Jeff Ponsky, MD
Jeffrey Ponsky · 61 min · Published Jun 2024
Video
From Idea to Ubiquity - the PEG Journey
Jeffrey Ponsky · Published Nov 2023
Podcast
Innovations in Surgery: PEG Tube
Jeffrey Ponsky · Published Aug 2023
What the experts said
In earlier days, separate individual ports provided more functionality and flexibility than multi-hole platforms for single-port surgery.
Current multi-hole platforms have improved functionality compared to earlier versions.
Multiple puncture holes in fascia was a concern with separate trocar approaches.
Most current multi-hole platforms have a skin barrier protector sleeve and require only one fascial incision.
The mass population is probably not going to adopt the robot for single-site surgery.
Different types of myotomy for achalasia have been tried, starting from the Heller one, circular or spiral.
Myotomies that kept both longitudinal and circular layers leaving only mucosa had complications such as outpouching.
Cutting just the circular layer provides length but may cause dilation problems because only mucosa remains without muscular support.
In animal model testing with stretching technique, total circular myotomy provides length but the esophagus loses strength.
Bilateral myotomy is capable of elongating the esophagus while keeping good compliance.
Magnets are very difficult to control their force and energy once used.
LINX is a potential in-between therapy, possibly more effective than current endoluminal therapies but maybe not as much of a barrier as Nissen, though potentially more physiologic.
LINX is a rosary of magnets that slide along so when swallowing, the bolus pushes the magnets apart and they lose some attraction force, making it more physiologic.
LINX developers seem to have figured out how to place it without erosions.
If a patient is already suffering what is believed to be a complication of gastroesophageal reflux disease (Barrett's esophagus), we should be aggressive about managing it rather than treating it expectantly, similar to a colon polyp.
It is not clear whether radiofrequency ablation is necessary for non-dysplastic Barrett's esophagus in some people's minds.
Data supporting radiofrequency ablation for non-dysplastic Barrett's will be coming down the road, though it takes a long time to generate.
In the New England Journal of Medicine study, there was a significant rate of buried glands in both radiofrequency ablation and control groups.
The percent of buried glands at baseline before any intervention was around 15% in the placebo group, which went up, while in the treatment group it went down.
Buried glands are starting to be understood as a natural state of Barrett's esophagus.
Radiofrequency ablation definitely decreases buried glands and does so more than acid suppression and placebo.
In settings where facilities are available and stones are known in the common bile duct ahead of time, direct common duct exploration is performed rather than ERCP.
Common bile duct exploration is done transcystically if possible, or by choledochotomy via regular laparoscopy if not.
In a review of 500 ERCPs from 10 different endoscopists, only 68% were able to clear the biliary tree.
In many Latin American countries, an endoscopist performs 100 ERCP cases over 10 years, not as everyday routine.
Gastric leaks and biliary leaks have very common closure rates and usually close in about 2 to 3 weeks.
Stents for gastric and biliary leaks are typically left in place for 4 to 6 weeks because it is not a big deal to remove them.
Chronic fistulas, especially tracheoesophageal fistulas managed for months through drainage, clips, and glues, require stents for much longer periods and have lower success rates.
After stent removal, patients are studied with appropriate imaging: intraoperative cholangiogram for biliary leaks or upper GI study for gastrointestinal tract leaks to verify closure.
To achieve 85% success in cannulating and working the biliary tree, at least 100 ERCP cases are needed on average.
Multiple authors have shown that exploration of the common bile duct is possible with decreased cost, same morbidity, and possibly even less morbidity than ERCP.