Scientific Program

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Station 1: The Difficult Colon Lab

Focus:

• dolichocolon, post-surgical anatomy, severe diverticular disease
• predictive loop management
• knowing when to continue, stop, or refer

Skills Acquisition Pathway:

1. Master scope handling – fine control of tip deflection, torque steering, and image stability.
2. Recognize and manage loops – identify loop patterns and apply effective reduction maneuvers.
3. Navigate efficiently – progress confidently to the cecum with correct anatomical orientation.
4. Optimize mucosal inspection – apply washing, retroflexion, and detection of subtle flat lesions.

Outcome: Build the essential foundation required for all advanced endoscopic procedures.

Station 2: EUS – FNA /FNB Acquisition Lab

Skills Acquisition Pathway:

1. Understand image orientation & anatomy – identify key structures and echogenic patterns.
2. Target lesions with confidence – stabilize the echoendoscope and position the needle path.
3. Perform needle puncture – coordinate needle movement precisely under real-time EUS guidance.
4. Optimize tissue acquisition – practice suction, fanning, and core sampling techniques.
5. Patient and lesion selection: when to sample — and when not to
6. FNA vs FNB decision logic: choosing the right technique for the clinical question
7. Needle selection: gauge, design, and indications
8. Scope position and stability: controlling the puncture platform
9. Needle techniques: fanning, torque, stroke length, suction strategy
10. Sample adequacy: what “good tissue” really means
11. Troubleshooting: bloody samples, insufficient cellularity, difficult access

Outcome: Acquire the fundamental skills necessary for high-quality diagnostic EUS.

Station 3: Polypectomy & EMR Lab

Not techniques. Decisions.

• cold vs hot resection in 2026
• fibrotic and non-lifting lesions
• piecemeal vs en-bloc: outcome-driven choices

Skills Acquisition Pathway:

1. Characterize lesions – determine when to use cold, hot, en-bloc EMR, or piecemeal resection.
2. Perform submucosal lifting – create a safe and adequate dissection plane with proper injection.
3. Control the snare effectively – practice optimal snare placement and activation.
4. Manage complications – learn immediate strategies for bleeding or deep mural injury.

Outcome: Gain essential modern polypectomy and EMR competencies for screening and therapy.

Station 4: Hemostasis

Skills Acquisition Pathway:

1. Recognize bleeding patterns – differentiate spurting, oozing, and exposed vessel lesions.
2. Perform injection therapy – control depth and volume for effective tamponade.
3. Apply mechanical hemostasis – place clips with accuracy and proper tissue capture.
4. Use thermal modalities – practice targeted coagulation with controlled energy delivery.

Outcome: Develop a complete toolbox for rapid and reliable endoscopic hemostasis.

Station 5: PEG Beyond the Procedure: Decision & Risk Management Lab

Because PEG is simple—until it isn’t.

PEG Component – Skills Acquisition Pathway:

1. Select a safe site – use transillumination and palpation to confirm landmarks.
2. Perform puncture & guidewire placement – practice controlled access and wire advancement.
3. Complete the PEG placement – simulate externalization and secure fixation of the tube.

Outcome: Master essential techniques for enteral access.

Station 6: Endoscopic Closure & Perforation Management Station

Stepwise strategies, not devices

• TTS vs OTSC
• sequential closure algorithms
• recognizing when endoscopy should stop

Skills Acquisition Pathway:

1. Identify defect types – distinguish mucosal, deep, and full-thickness injuries.
2. Perform TTS clip closure – learn proper grasping, tissue approximation, and clip deployment.
3. Use OTSC systems – practice closure of large or complex defects.
4. Simulate endoscopic suturing – understand indications and basic suturing mechanics.

Outcome: Build confidence in managing endoscopic complications and restoring GI integrity.

Station 7: ERCP Cannulation & Therapeutic Techniques Station

Skills Acquisition Pathway:

1. Identify papillary anatomy – understand variations and choose tailored cannulation strategies.
2. Develop refined wire control – practice controlled guidewire advancement in biliary/pancreatic ducts.
3. Achieve selective cannulation – follow step-by-step algorithms for safe and efficient access.
4. Simulate therapeutic maneuvers – stenting, sphincterotomy, and stone extraction (demo).

Outcome: Gain the core competencies needed for safe and effective ERCP practice.

Station 8: Stenting Lab: Acquisition Skills

Not about devices. About control.

• Choosing the right stent
• Deploying with precision
• Managing errors before they become complications

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In medicine, the terms medical error, complication, and assumed risk (or accepted/justified risk) have distinct meanings, both from a medical and a legal perspective, particularly with regard to the physician’s liability. Understanding the difference between error, complication, and assumed risk is essential not only in a litigation context, but especially in everyday clinical practice. A complication may occur even when the medical indication is correct and the procedure is performed in accordance with established protocols, whereas a medical error involves a deviation from the applicable standard of professional care. Assumed risk, in turn, requires that the patient be genuinely and properly informed, with such information being documented, rather than treated as a mere formality. This presentation aims to provide physicians with clear reference points for understanding these distinctions, supported by practical examples from daily practice, and to emphasize the role of documentation, communication, and sound medical decision-making in building professional legitimacy. The objective is not to create fear or promote defensive medicine, but to enhance safety in medical practice and reduce conflict through clarity, accountability, and balance.

Speakers: Catalina Bordianu, Valentina Saygo

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Chairs:

Lectures:

• Post-Procedure Damage Control. The procedure is over. The risk is not.
• Mastering ESD: Key Strategies, Pitfalls, and Technical Pearls for Difficult Lesions
• This lesion: EMR, ESD, eFTR or surgery?
• EUS When Things Go Wrong: Troubleshooting Access, Bloody Samples, and Failed Tissue Acquisition

Discussion and wrap-up of the theoretical session

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