# Foundations of Minimally Invasive & Endoscopic Surgery — GCMD Library living collection

Updated: n/a · 27 episodes · 213 cited statements

## Episodes
### History & Pioneers of Endoscopic Surgery
- [Endoscopy and Surgery](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720) — video · 11:29 · [machine version](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720.md)
- [Special Lecture:  Dr. Jeffrey Ponsky | St. George's University](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726) — video · 45:44 · [machine version](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726.md)
- [ACS Icons in Surgery | Jeffrey L. Ponsky, MD, FACS](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682) — video · 20:00 · [machine version](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682.md)
- [Meet the Master: Jeffrey L. Ponsky, MD, FACS](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683) — video · 1:05:06 · [machine version](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683.md)
- [SAGES Stories Episode 11 – Jeff Ponsky, MD](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684) — video · 1:01:24 · [machine version](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684.md)
- [Residency Advice:  Dr. Jeffrey Ponsky | St. George's University](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685) — video · 2:20 · [machine version](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685.md)
- [Jeffrey L. Ponsky, MD, FACS](https://library.globalcastmd.com/watch/jeffrey-l-ponsky-md-facs-13688) — article · [machine version](https://library.globalcastmd.com/watch/jeffrey-l-ponsky-md-facs-13688.md)
- [Jeffrey Ponsky: Portrait of a SAGES Pioneer](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723) — video · 50:04 · [machine version](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723.md)
- [Jeffrey L. Ponsky Master Educator in Endoscopy](https://library.globalcastmd.com/watch/jeffrey-l-ponsky-master-educator-in-endoscopy-13735) — video · [machine version](https://library.globalcastmd.com/watch/jeffrey-l-ponsky-master-educator-in-endoscopy-13735.md)
- [SAGES/ALACE Symposium: Integrating New Technologies, Old Tricks, and Operative Approaches](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727) — video · 12:32 · [machine version](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727.md)

### Innovations & Surgical Entrepreneurship
- [From Idea to Ubiquity - the PEG Journey](https://library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719) — video · [machine version](https://library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719.md)
- [Ponsky and Gauderer invent the PEG tube](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724) — video · 7:03 · [machine version](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724.md)
- [Lessons learned from the introduction of a new endoscopic procedure: PEG](https://library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725) — video · [machine version](https://library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725.md)
- [Innovations in Surgery: PEG Tube](https://library.globalcastmd.com/watch/innovations-in-surgery-peg-tube-13737) — podcast · [machine version](https://library.globalcastmd.com/watch/innovations-in-surgery-peg-tube-13737.md)
- [From Idea to Ubiquity](https://library.globalcastmd.com/watch/from-idea-to-ubiquity-13731) — video · [machine version](https://library.globalcastmd.com/watch/from-idea-to-ubiquity-13731.md)

### Advanced Endoscopic Techniques
- [International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)](https://library.globalcastmd.com/watch/international-multicenter-experience-with-peroral-endoscopic-myotomy-for-the-treatment-of-spastic-esophageal-disorders-refractory-to-medical-therapy-13693) — article · [machine version](https://library.globalcastmd.com/watch/international-multicenter-experience-with-peroral-endoscopic-myotomy-for-the-treatment-of-spastic-esophageal-disorders-refractory-to-medical-therapy-13693.md)
- [Peroral endoscopic myotomy (POEM) leads to similar results in patients with and without prior endoscopic or surgical therapy](https://library.globalcastmd.com/watch/peroral-endoscopic-myotomy-leads-to-similar-results-in-patients-with-and-without-prior-endoscopic-or-surgical-therapy-13694) — article · [machine version](https://library.globalcastmd.com/watch/peroral-endoscopic-myotomy-leads-to-similar-results-in-patients-with-and-without-prior-endoscopic-or-surgical-therapy-13694.md)
- [Retrograde myotomy: a variation in per oral endoscopic myotomy (POEM) technique](https://library.globalcastmd.com/watch/retrograde-myotomy-a-variation-in-per-oral-endoscopic-myotomy-technique-13695) — article · [machine version](https://library.globalcastmd.com/watch/retrograde-myotomy-a-variation-in-per-oral-endoscopic-myotomy-technique-13695.md)
- [How i do it: per-oral endoscopic myotomy (POEM)](https://library.globalcastmd.com/watch/how-i-do-it-per-oral-endoscopic-myotomy-13696) — article · [machine version](https://library.globalcastmd.com/watch/how-i-do-it-per-oral-endoscopic-myotomy-13696.md)
- [POEM by Surgeons – Dr. Jeffrey Ponsky](https://library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722) — video · [machine version](https://library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722.md)
- [Comparison of anterior transgastric access techniques for natural orifice translumenal endoscopic surgery](https://library.globalcastmd.com/watch/comparison-of-anterior-transgastric-access-techniques-for-natural-orifice-translumenal-endoscopic-surgery-13697) — article · [machine version](https://library.globalcastmd.com/watch/comparison-of-anterior-transgastric-access-techniques-for-natural-orifice-translumenal-endoscopic-surgery-13697.md)
- [Current status of natural orifice translumenal endoscopic surgery (NOTES)](https://library.globalcastmd.com/watch/current-status-of-natural-orifice-translumenal-endoscopic-surgery-13698) — article · [machine version](https://library.globalcastmd.com/watch/current-status-of-natural-orifice-translumenal-endoscopic-surgery-13698.md)
- [Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and gastrotomy site selection by using a hybrid technique](https://library.globalcastmd.com/watch/transgastric-natural-orifice-transluminal-endoscopic-surgery-peritoneoscopy-in-humans-a-pilot-study-in-efficacy-and-gastrotomy-site-selection-by-using-a-hybrid-technique-13699) — article · [machine version](https://library.globalcastmd.com/watch/transgastric-natural-orifice-transluminal-endoscopic-surgery-peritoneoscopy-in-humans-a-pilot-study-in-efficacy-and-gastrotomy-site-selection-by-using-a-hybrid-technique-13699.md)
- [Intramural Surgery: A New Vista in Minimally Invasive Therapy](https://library.globalcastmd.com/watch/intramural-surgery-a-new-vista-in-minimally-invasive-therapy-13692) — article · [machine version](https://library.globalcastmd.com/watch/intramural-surgery-a-new-vista-in-minimally-invasive-therapy-13692.md)
- [Overview of Single Incision Surgery Tool Box and Technique: Jeffrey Ponsky, M.D.](https://library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728) — video · [machine version](https://library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728.md)

### General Endoscopy Education
- [Endoscopy, An Issue of Surgical Clinics, E-Book](https://library.globalcastmd.com/watch/endoscopy-an-issue-of-surgical-clinics-e-book-13717) — article · [machine version](https://library.globalcastmd.com/watch/endoscopy-an-issue-of-surgical-clinics-e-book-13717.md)
- [All About Advanced Surgical Endoscopy](https://library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744) — podcast · [machine version](https://library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744.md)

## Chapters
- [0:12](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=12) Early life, family influence, and path to surgery (Ep 3)
- [4:36](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=276) Residency elective in gastroenterology and invention of endoscopic tattooing (Ep 3)
- [7:51](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=471) Acquiring the first scope and becoming department chairman (Ep 3)
- [10:02](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=602) SAGES, laparoscopic cholecystectomy, and train-the-trainers programs (Ep 3)
- [12:01](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=721) American Board of Surgery directorship and chairmanship (Ep 3)
- [13:54](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=834) Mentorship philosophy and life balance (Ep 3)
- [16:48](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=1008) Personal relationship with mentee Todd Ponsky (Ep 3)
- [18:16](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=1096) Equestrian hobby and its therapeutic value (Ep 3)
- [19:11](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=1151) Surgical philosophy: the endoscope as operative vehicle (Ep 3)
- [0:08](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=8) Early Life and Path to Surgery (Ep 4)
- [3:38](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=218) Entry into Endoscopy and the Scope in the Trunk (Ep 4)
- [10:40](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=640) Invention of PEG and Early Academic Career (Ep 4)
- [22:07](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1327) Mount Sinai Years and Academic Philosophy (Ep 4)
- [28:13](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1693) Leadership in ASGE and SAGES (Ep 4)
- [34:49](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2089) NOTES Era and Noscar Formation (Ep 4)
- [40:00](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2400) Cleveland Clinic Tenure and Current Practice (Ep 4)
- [53:24](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3204) Intramural Surgery and Future of Endoscopy (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=0) Introduction and Early Life (Ep 5)
- [6:35](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=395) Medical School and Surgical Training (Ep 5)
- [16:44](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1004) Introduction to Endoscopy (Ep 5)
- [28:20](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1700) Development of the PEG Tube (Ep 5)
- [31:50](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1910) Career Transitions and ERCP (Ep 5)
- [47:47](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2867) SAGES History and Evolution (Ep 5)
- [51:06](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3066) Life Philosophy and Closing (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=0) Introduction and Question Setup (Ep 6)
- [0:20](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=20) Academic Prerequisites and Letter Selection (Ep 6)
- [1:08](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=68) Interview Strategy and Engagement (Ep 6)
- [0:06](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=6) History of Surgeons in Endoscopy: From Fiber Optics to Therapeutic Applications (Ep 1)
- [3:39](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=219) Endoscopy as Integral to Modern Surgical Practice (Ep 1)
- [6:05](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=365) Advanced Endoscopic Techniques and Surgeon-Gastroenterologist Collaboration (Ep 1)
- [8:36](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=516) Future Vision: Transmural Surgery, Robotics, and Endoscopic Innovation (Ep 1)
- [0:05](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=5) Early Life and Medical Training in Cleveland (Ep 8)
- [3:00](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=180) Entry into Endoscopy and Acquiring First Scope (Ep 8)
- [7:46](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=466) Development of PEG Procedure (Ep 8)
- [9:40](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=580) Mount Sinai Chairmanship and Endoscopy Courses (Ep 8)
- [11:35](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=695) Founding and Growth of SAGES (Ep 8)
- [16:06](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=966) SAGES Culture and International Expansion (Ep 8)
- [19:52](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1192) International Collaboration and Journal Development (Ep 8)
- [24:36](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1476) Industry Partnerships and Corporate Council (Ep 8)
- [26:46](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1606) Evolution of SAGES Educational Courses (Ep 8)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Basil Morrison in England was marking the tips of polyps with India ink to track polyp behavior over time. — Jeffrey L. Ponsky (clinical) [Ep 3 · 6:47](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=407)
- In 1975, Ponsky injected pelican India ink at the base of polypectomy sites so surgeons could identify the location if pathology returned malignant. The injection needle cost $160 from Olympus. — Jeffrey L. Ponsky (clinical) [Ep 3 · 7:01](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=421)
- Endoscopic marking of colonic lesions with India ink remains useful in the laparoscopic era when surgeons cannot palpate the colon. — Jeffrey L. Ponsky (clinical) [Ep 3 · 7:28](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=448)
- In the mid-1970s, gastroenterologists at Mount Sinai Hospital could not routinely reach the cecum during colonoscopy because long scopes had not yet been invented. — Jeffrey L. Ponsky (clinical) [Ep 3 · 6:15](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=375)
- The first endoscope Ponsky owned (purchased late 1974) was kept in his car trunk and cleaned with green soap before use. — Jeffrey L. Ponsky (clinical) [Ep 3 · 8:48](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=528)
- While scoping pediatric patients with Michael Gauer, Ponsky observed transillumination of the abdominal wall and finger indentation visible through the endoscope, which led to development of the PEG procedure. — Jeffrey L. Ponsky (clinical) [Ep 3 · 9:06](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=546)
- Jacques Perrisat presented a video on laparoscopic cholecystectomy at a SAGES meeting in Louisville, Kentucky in 1989, igniting widespread adoption. — Jeffrey L. Ponsky (clinical) [Ep 3 · 10:44](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=644)
- After Perrisat's 1989 demonstration, Ponsky's Mount Sinai laboratory conducted train-the-trainers courses for surgeons at major hospitals. — Jeffrey L. Ponsky (clinical) [Ep 3 · 10:57](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=657)
- The American Board of Surgery invited SAGES to nominate three candidates for a board director position representing minimally invasive surgery; Ponsky was selected and later became chairman. — Jeffrey L. Ponsky (clinical) [Ep 3 · 12:01](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=721)
- As American Board of Surgery chairman, Ponsky contributed to developing minimally invasive surgery curricula, board examination questions, and endoscopy training requirements for surgical residents. — Jeffrey L. Ponsky (clinical) [Ep 3 · 12:42](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=762)
- Ponsky trained 35 endoscopic surgery fellows, many of whom became SAGES presidents and leaders in the American Board of Surgery. — Jeffrey L. Ponsky (clinical) [Ep 3 · 13:54](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=834)
- Ponsky's surgical philosophy: the endoscope is a vehicle (like a car or bus) that transports surgeons to operative sites for procedures such as POEM, POP, Zenker's repair, and NOTES, not merely a tool for mucosal inspection. — Jeffrey L. Ponsky (opinion) [Ep 3 · 19:11](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=1151)
- In 1998, Ponsky welcomed a fellow (spk_4) to Cleveland Clinic staff, aligning their clinic and operative schedules so Ponsky was 30 feet away for clinical or intraoperative questions. (clinical) [Ep 3 · 16:48](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=1008)
- Ponsky had a 2.027 GPA graduating from Cleveland Heights High School and his college counselor recommended trade school instead of college. — Jeffrey Ponsky (clinical) [Ep 5 · 6:49](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=409)
- Ponsky's transformation in college came from memorizing everything and studying constantly, discovering he had an exceptional memory that allowed him to 'eat the book and spit it out.' — Jeffrey Ponsky (opinion) [Ep 5 · 9:17](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=557)
- Gastroenterologists at University Hospitals refused to train surgeons in endoscopy, telling Ponsky 'we're not training any surgeons.' — Jeffrey Ponsky (clinical) [Ep 5 · 25:21](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1521)
- Ponsky trained in endoscopy with Jim King in Canton, Ohio, performing approximately 500 cases over 5-6 months during an extended elective. — Jeffrey Ponsky (clinical) [Ep 5 · 25:47](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1547)
- Early endoscopes were cleaned with green soap and stored in the back of cars, without high-level disinfection protocols. Operators did not wear gloves during procedures. — Jeffrey Ponsky (clinical) [Ep 5 · 26:57](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1617)
- The PEG (percutaneous endoscopic gastrostomy) was developed in May 1979 by Ponsky and pediatric gastroenterologist Mike Gower, with the first five cases performed on babies with birth asphyxia and psychomotor retardation. — Jeffrey Ponsky (clinical) [Ep 5 · 31:23](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1883)
- The PEG procedure was developed without IRB approval, only discussing the approach with patients' families. — Jeffrey Ponsky (clinical) [Ep 5 · 31:31](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1891)
- Ponsky became chief of surgery at Mount Sinai Hospital at age 32 in 1979. — Jeffrey Ponsky (clinical) [Ep 5 · 31:50](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1910)
- Ponsky performed 1,600 colonoscopies in a single year during his practice. — Jeffrey Ponsky (clinical) [Ep 5 · 41:34](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2494)
- The distal splenorenal shunt, once considered a great operation based on physiology to reduce variceal pressure without decreasing portal flow, became obsolete when endoscopic variceal banding was introduced. — Jeffrey Ponsky (clinical) [Ep 5 · 40:27](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2427)
- Ponsky performed 180 vertical banded gastroplasties in one year in the mid-1980s, an operation that later required reversal in many patients. — Jeffrey Ponsky (clinical) [Ep 5 · 41:05](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2465)
- ERCP was developed primarily in Japan by Itaru Oi and colleagues, with contributions from German physicians and Peter Cotton's group in London. — Jeffrey Ponsky (clinical) [Ep 5 · 43:09](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2589)
- Ponsky learned ERCP primarily through watching videos and self-teaching, then traded training with George Brodmerkel in Pittsburgh—teaching him laparoscopy under local anesthesia in exchange for learning sphincterotomy. — Jeffrey Ponsky (clinical) [Ep 5 · 43:40](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2620)
- Walter Pore taught pinch grafting technique at Metro Hospital, where students would inject local anesthesia, harvest small 'postage stamp' skin grafts from the thigh, and apply them to debrided bedsores. Pore emphasized giving patients zinc supplementation. — Jeffrey Ponsky (clinical) [Ep 5 · 21:12](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1272)
- Early SAGES meetings focused on surgical problem-solving with endoscopy, addressing topics like managing bowel obstruction, evaluating suture lines, and treating intestinal volvulus endoscopically—distinct from ASGE's focus. — Jeffrey Ponsky (clinical) [Ep 5 · 48:24](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2904)
- When SAGES started, it had approximately 300 members. When Ponsky became president in 1990, the society was giving courses on surgical endoscopy and its relationship to surgical problem-solving. — Jeffrey Ponsky (clinical) [Ep 5 · 28:30](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1710)
- Jacques Perissat showed the video of laparoscopic cholecystectomy in the exhibit hall at the SAGES meeting in Louisville, Kentucky, marking a pivotal moment when Ponsky was SAGES president. — Jeffrey Ponsky (clinical) [Ep 5 · 28:48](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1728)
- When laparoscopic cholecystectomy was introduced, instruments could not be purchased and surgeons had to use gynecologic instruments initially. — Jeffrey Ponsky (clinical) [Ep 5 · 29:04](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1744)
- Ponsky took one of the first laparoscopic cholecystectomy courses taught by Nat Soper, George Bercy, John Hunter, and John Sackier in Salt Lake City. — Jeffrey Ponsky (clinical) [Ep 5 · 29:10](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1750)
- Ponsky's first two laparoscopic cholecystectomies at Mount Sinai were proctored by David Dupper, who had performed only 8 cases himself at that time. The first patient was a member of the hospital's board of trustees. — Jeffrey Ponsky (clinical) [Ep 5 · 29:27](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1767)
- Ponsky advocated to the Residency Review Committee (when Joe Fisher was head) for a minimum endoscopy requirement in general surgery training. The initial requirement of 50 cases was controversial but established endoscopy as a required component of general surgery. — Jeffrey Ponsky (clinical) [Ep 5 · 50:09](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3009)
- Ponsky became director of surgical endoscopy at University Hospitals at age 29 as a new attending. — Jeffrey Ponsky (clinical) [Ep 5 · 30:31](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1831)
- Mount Sinai Hospital had an animal laboratory that was larger than Cleveland Clinic's laboratory, providing Ponsky freedom to conduct courses and train fellows. — Jeffrey Ponsky (clinical) [Ep 5 · 32:54](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1974)
- Modern endoscopy began with Basil Hersowitz in the late 1950s when he integrated flexible fiber optic technology to produce endoscopic instruments which could go through the mouth or rectum to produce images. — Jeff Ponsky (clinical) [Ep 1 · 0:59](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=59)
- Surgeons and gastroenterologists were involved in endoscopy from the very beginning. — Jeff Ponsky (clinical) [Ep 1 · 1:29](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=89)
- Gastroenterologists such as Gene Oberholt and Jerry Way developed diagnostic applications of endoscopy. — Jeff Ponsky (clinical) [Ep 1 · 1:50](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=110)
- Surgeons saw the therapeutic applications of endoscopy. — Jeff Ponsky (clinical) [Ep 1 · 2:08](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=128)
- Hiromi Shia and Bill Wolf developed polypectomy by putting a metal wire around polyps and applying electricity to remove them. — Jeff Ponsky (clinical) [Ep 1 · 2:17](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=137)
- Greg Stigman applied the principle of banding hemorrhoids in the rectum to esophageal varices. — Jeff Ponsky (clinical) [Ep 1 · 2:37](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=157)
- Michael Godard and Jeff Ponsky applied surgical principles of percutaneous techniques to place feeding tubes using the endoscope to guide the procedure. — Jeff Ponsky (clinical) [Ep 1 · 2:50](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=170)
- Nipsa Hendra, a surgeon in Germany, developed the first stenting of the bile duct. — Jeff Ponsky (clinical) [Ep 1 · 3:20](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=200)
- Surgeons have been involved in the advances in endoscopy, particularly the therapeutic advances. — Jeff Ponsky (opinion) [Ep 1 · 3:31](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=211)
- Bariatric and gastrointestinal surgeons today use endoscopy to look at their anastomoses and test them after surgery. — Jeff Ponsky (clinical) [Ep 1 · 4:30](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=270)
- Surgeons use endoscopy to stent leaks or perform therapeutic stenting of strictures. — Jeff Ponsky (clinical) [Ep 1 · 4:42](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=282)
- Endoscopy for surgeons today is a technique used to augment surgical procedures. — Jeff Ponsky (opinion) [Ep 1 · 4:59](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=299)
- Not all surgeons perform ERCP. — Jeff Ponsky (clinical) [Ep 1 · 5:07](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=307)
- Surgeons in bariatric surgery use endoscopy daily to assess surgical results, look for leaks, stent leaks, place drainage tubes, and improve treatment of complications. — Jeff Ponsky (clinical) [Ep 1 · 5:12](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=312)
- Endoscopy is part of what surgeons do today. — Jeff Ponsky (opinion) [Ep 1 · 5:31](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=331)
- Surgeons were the leaders in developing advanced endoscopic techniques because they asked what therapeutic procedures could be performed through the endoscope. — Jeff Ponsky (opinion) [Ep 1 · 6:05](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=365)
- Endoscopic submucosal dissection can be used to remove T2 tumors and extensive spreading tumors of the colon without the need for surgery. — Jeff Ponsky (clinical) [Ep 1 · 6:22](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=382)
- Emory Gorgon at the Cleveland Clinic has extensive experience in endoscopic submucosal dissection, including in the colon. — Jeff Ponsky (clinical) [Ep 1 · 6:38](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=398)
- Pre-malignant and early malignant lesions in the esophagus can be removed endoscopically. — Jeff Ponsky (clinical) [Ep 1 · 6:50](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=410)
- Division of esophageal muscles to treat achalasia can be performed endoscopically where surgery was previously required. — Jeff Ponsky (clinical) [Ep 1 · 6:54](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=414)
- Endoscopic techniques augment surgery rather than replace it, allowing selection of the right procedure for the right patient. — Jeff Ponsky (opinion) [Ep 1 · 7:09](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=429)
- The only place surgeons and gastroenterologists fail is when they fail to work together. — Jeff Ponsky (opinion) [Ep 1 · 7:35](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=455)
- The gastroenterology community excels at endoscopic ultrasound, which has led to tremendous therapeutic advances. — Jeff Ponsky (opinion) [Ep 1 · 7:45](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=465)
- The ultimate potential of endoscopic ultrasound will not be reached unless surgeons and gastroenterologists work together. — Jeff Ponsky (opinion) [Ep 1 · 7:50](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=470)
- At the Cleveland Clinic, surgeons and gastroenterologists work together, combining surgical and endoscopic techniques. — Jeff Ponsky (clinical) [Ep 1 · 8:03](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=483)
- Collaboration between surgeons and gastroenterologists augments the ability of endoscopy and extends the capacity of the specialty. — Jeff Ponsky (opinion) [Ep 1 · 8:26](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=506)
- In 10 years, the field will not recognize what is being done today in endoscopy. — Jeff Ponsky (opinion) [Ep 1 · 8:37](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=517)
- Transmural surgery will be possible in the future, including performing resections of pieces of bowel, removing tumors, and sewing up the lumen endoscopically. — Jeff Ponsky (opinion) [Ep 1 · 8:56](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=536)
- Gastrointestinal anastomoses will be performed endoscopically or using combined endoscopic and percutaneous techniques in the future. — Jeff Ponsky (opinion) [Ep 1 · 9:18](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=558)
- Surgical complications will be managed endoscopically in the future using ultrasound and endoscopy. — Jeff Ponsky (opinion) [Ep 1 · 9:32](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=572)
- New modalities will be integrated into endoscopy to deal with biliary disease, colonic disease, pancreatic disease, gastric disease, and inflammatory bowel disease. — Jeff Ponsky (opinion) [Ep 1 · 9:42](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=582)
- The robot refines surgical maneuvers and helps perform procedures better and more exactly. — Jeff Ponsky (opinion) [Ep 1 · 10:25](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=625)
- Jeff Ponsky was initially a critic of robotics in laparoscopic surgery when it first began because it was expensive and he thought it unnecessary. — Jeff Ponsky (opinion) [Ep 1 · 10:35](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=635)
- Robotics must be integrated into everything surgeons do. — Jeff Ponsky (opinion) [Ep 1 · 10:47](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=647)
- Robotics will be used with flexible endoscopy just as it has been used with colorectal and intestinal surgery. — Jeff Ponsky (opinion) [Ep 1 · 10:52](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=652)
- In 1979, Ponsky and Michael Gauderer performed the first percutaneous endoscopic gastrostomy (PEG) procedures in five brain-damaged infants who were scheduled for open gastrostomy, after observing transillumination of the abdominal wall during upper endoscopy. — Jeffrey Ponsky (clinical) [Ep 8 · 7:46](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=466)
- The American Board of Surgery mandated around 1980 that surgical residents must have experience in endoscopy, but most programs rotated residents to gastroenterology services where they only observed rather than performed procedures. — Jeffrey Ponsky (guideline) [Ep 8 · 10:18](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=618)
- SAGES was founded around 1980 by Jerry Marks and other surgeons including John Coller, Ken Ford, John Van Sant, and Jim Lynn because ASGE did not want surgical papers on their programs frequently and excluded surgeons from leadership roles. — Jeffrey Ponsky (clinical) [Ep 8 · 11:35](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=695)
- During Ponsky's 18-month SAGES presidency (approximately 1989-1990), membership grew from 300 to 2000 members, driven by the introduction of laparoscopic cholecystectomy after Jacques Perrissat showed his video at a Louisville meeting in 1989. — Jeffrey Ponsky (epidemiological) [Ep 8 · 15:17](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=917)
- SAGES developed a flat organizational structure unlike hierarchical traditional surgical societies, encouraging young surgeons to participate equally on committees and at social events regardless of seniority. — Jeffrey Ponsky (opinion) [Ep 8 · 16:43](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1003)
- SAGES changed its name from Society of Gastrointestinal Endoscopic Surgeons to Society of Gastrointestinal and Endoscopic Surgeons in the last decade, making both endoscopy and general GI surgery equal parts of the organization's mission. — Jeffrey Ponsky (clinical) [Ep 8 · 18:05](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1085)
- Current SAGES membership is close to 7,000 members. — Jeffrey Ponsky (epidemiological) [Ep 8 · 18:35](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1115)
- Barbara Saltzman (later Barbara Bercy after marrying George Bercy) served as SAGES administrator from the early years and was critical to establishing the organization's culture and managing its growth. — Jeffrey Ponsky (clinical) [Ep 8 · 13:55](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=835)
- In early laparoscopic common bile duct exploration, before mastering laparoscopic suturing, surgeons would twist the two suture ends together like a twist-tie and secure them with a clip rather than tying knots. — Jeffrey Ponsky (clinical) [Ep 8 · 42:06](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2526)
- Ponsky was the first SAGES member appointed to the American Board of Surgery and later served as chairman of the board. — Jeffrey Ponsky (clinical) [Ep 8 · 42:46](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2566)
- The video camera was essential to the laparoscopic revolution because it allowed the entire surgical team to see what the surgeon was doing, unlike earlier laparoscopy where only the surgeon looking through the eyepiece could see the operative field. — Jeffrey Ponsky (clinical) [Ep 8 · 39:01](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2341)
- Eddie Joe Reddick and Doug Olson in Nashville, and Barry McKernan and Bill Saye in Marietta, Georgia (who did the first laparoscopic cholecystectomy in the United States) were the key early teachers of the procedure. — Jeffrey Ponsky (clinical) [Ep 8 · 39:49](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2389)
- SAGES initially trained trainers (including John Hunter, Nat Soper, John Saker, George Bercy) in laparoscopic cholecystectomy before offering courses to the broader surgical community. — Jeffrey Ponsky (clinical) [Ep 8 · 40:17](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2417)
- In the early laparoscopic era, instrument shortages were severe; surgeons needed personal connections to manufacturers to obtain equipment and often used gynecologic instruments adapted for general surgery. — Jeffrey Ponsky (clinical) [Ep 8 · 40:57](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2457)
- George Bercy at age 96 continues to develop new surgical instruments and regularly contacts Ponsky to review new designs, including a smaller chip-camera choledochoscope and a VTO scope for cardiac surgeons to view valve anastomoses without loupes. — Jeffrey Ponsky (clinical) [Ep 8 · 37:57](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2277)
- Walter Pore, in his mid-80s, continues to hold NIH grants and remains relevant in research and lecturing, demonstrating that surgeons can maintain professional relevance well into advanced age. — Jeffrey Ponsky (opinion) [Ep 8 · 35:59](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2159)
- Three of Ponsky's fellows became SAGES presidents: John Mellinger, Brian Duncan, and Jeff Marks. — Jeffrey Ponsky (clinical) [Ep 8 · 31:14](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1874)
- Japanese surgeons, particularly through Choichi Segawa, Manabu Yamamoto, and others, were instrumental in teaching SAGES members advanced endoscopic techniques including POEM and endoscopic submucosal dissection. — Jeffrey Ponsky (clinical) [Ep 8 · 22:17](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1337)
- The first PEG procedures in 1979 were performed without formal IRB review; consent was obtained by explaining to mothers that the team would attempt the endoscopic approach but would convert to open gastrostomy if unsuccessful. — Jeffrey Ponsky (clinical) [Ep 8 · 8:40](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=520)
- Ponsky's mother-in-law purchased his first endoscope for $5,200 as a Christmas/Hanukkah gift after he was blocked from using the university gastroenterology department's equipment. — Jeffrey Ponsky (clinical) [Ep 8 · 5:52](https://library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=352)
- Flexible fiber optic gastrointestinal endoscopy began around 1958 when Hersowitz at the University of Michigan developed a method using glass fibers to transmit images. — Todd Ponsky (clinical) [Ep 12 · 0:12](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=12)
- In the 1960s, flexible endoscopy was used only for visualization of the GI tract without therapeutic interventions. — Todd Ponsky (clinical) [Ep 12 · 0:34](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=34)
- In the early 1970s, Shina, a surgeon in New York, developed the ability to remove polyps from the GI tract endoscopically. — Todd Ponsky (clinical) [Ep 12 · 0:45](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=45)
- Endoscopic polyp removal was significant because it enabled removal of polyps before they became cancer. — Todd Ponsky (clinical) [Ep 12 · 0:48](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=48)
- The chief of gastroenterology at Case Western Reserve University refused to train surgical residents in endoscopy in the early 1970s. — Todd Ponsky (clinical) [Ep 12 · 1:38](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=98)
- After completing approximately 500 endoscopy cases during training in Canton, Ohio, the speaker was again refused permission to participate in endoscopy training at Case Western Reserve because he was a surgeon. — Todd Ponsky (clinical) [Ep 12 · 2:09](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=129)
- By the end of residency, the speaker had displaced the gastroenterology service at University Hospitals through independent endoscopy practice using a personally owned endoscope. — Todd Ponsky (clinical) [Ep 12 · 3:02](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=182)
- Children with brain damage often required long-term feeding tubes. — Todd Ponsky (clinical) [Ep 12 · 3:18](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=198)
- The speaker and Michael Gauderer developed a technique to place feeding tubes endoscopically through the abdominal wall. — Todd Ponsky (clinical) [Ep 12 · 3:18](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=198)
- The PEG tube procedure was probably the beginning of minimally invasive surgery. — Todd Ponsky (opinion) [Ep 12 · 3:44](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=224)
- The speaker moved to Mount Sinai Hospital in 1979, almost 40 years before this presentation, and began performing PEG tube placement in adults. — Todd Ponsky (clinical) [Ep 12 · 3:51](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=231)
- Olympus, Ross Laboratories, and Eaton Laboratory all declined interest in commercializing the PEG tube when initially contacted. — Todd Ponsky (clinical) [Ep 12 · 4:09](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=249)
- Marlon Yonker owned a small endoscopy company called American Endoscopy and agreed to manufacture the PEG tube. — Todd Ponsky (clinical) [Ep 12 · 4:19](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=259)
- American Endoscopy was sold to Bard Endoscopy in 1986. — Todd Ponsky (clinical) [Ep 12 · 4:40](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=280)
- The PEG tube is now used and overused throughout the world. — Todd Ponsky (opinion) [Ep 12 · 4:53](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=293)
- The PEG tube was the first minimally invasive surgical procedure. — Todd Ponsky (opinion) [Ep 12 · 4:56](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=296)
- In the era of PEG development, innovators could directly contact company representatives who would work collaboratively in garages and laboratories to develop prototypes. — Todd Ponsky (clinical) [Ep 12 · 5:04](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=304)
- Modern medical device innovation faces greater challenges due to FDA regulations compared to the 1970s-1980s era. — Todd Ponsky (opinion) [Ep 12 · 5:41](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=341)
- The PEG tube has become a standard procedure. — Todd Ponsky (clinical) [Ep 12 · 6:05](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=365)
- Surgical endoscopy now includes procedures to divide muscles for achalasia, a condition where people cannot swallow. — Todd Ponsky (clinical) [Ep 12 · 6:18](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=378)
- Surgical endoscopy is used to treat Zenker's diverticulum, an outpouching of the esophagus causing swallowing difficulty. — Todd Ponsky (clinical) [Ep 12 · 6:26](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=386)
- Surgery is now performed through the endoscope. — Todd Ponsky (clinical) [Ep 12 · 6:33](https://library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=393)
- In 1973, Dr. Ponsky was refused endoscopy training by Case Western Reserve's gastroenterology department, with the chief stating 'we're not going to train a surgeon to do endoscopy.' — Jeffrey L. Ponsky (clinical) [Ep 4 · 4:49](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=289)
- Dr. Ponsky performed approximately 500 endoscopies during a 4-6 month fellowship with Jim King in Canton, Ohio in 1974. — Jeffrey L. Ponsky (clinical) [Ep 4 · 6:06](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=366)
- Early endoscopy disinfection consisted of washing scopes with green soap and hanging them to dry, without gloves even for colonoscopy, and without high-level disinfection or washing machines. — Jeffrey L. Ponsky (clinical) [Ep 4 · 10:04](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=604)
- Dr. Ponsky published the first report of endoscopic tattooing with India ink in 1975 to mark colonic lesions for surgical localization. — Jeffrey L. Ponsky (clinical) [Ep 4 · 29:06](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1746)
- Percutaneous endoscopic gastrostomy (PEG) was developed by Dr. Ponsky and Michael Gower in May 1979, with the first 5 cases performed in infants at Rainbow Babies and Children's Hospital. — Jeffrey L. Ponsky (clinical) [Ep 4 · 15:27](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=927)
- The first adult PEG procedures were performed at Mount Sinai Hospital shortly after the initial pediatric cases in 1979. — Jeffrey L. Ponsky (clinical) [Ep 4 · 15:40](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=940)
- PEG was presented at the ASGE plenary session in Salt Lake City in 1980, where Peter Cotton stated 'I'm only sorry that I didn't think of this.' — Jeffrey L. Ponsky (opinion) [Ep 4 · 16:01](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=961)
- Transillumination in infants was critical to PEG development because the light shone through the thin abdominal wall, allowing visualization of stomach apposition to the abdominal wall. — Jeffrey L. Ponsky (clinical) [Ep 4 · 17:20](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1040)
- Early PEG tubes were fashioned from Pezzer catheters with Bunsen burner tubing as bolsters and medicut IV catheters as dilators. — Jeffrey L. Ponsky (clinical) [Ep 4 · 18:02](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1082)
- The technique of stretching the rubber tube to make it thinner for easier insertion through the dilating catheter was discovered by accident while walking down a hospital hallway. — Jeffrey L. Ponsky (clinical) [Ep 4 · 18:38](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1118)
- Using a snare around the puncturing needle to grasp the suture proved more reliable than attempting to grab it with biopsy forceps during PEG placement. — Jeffrey L. Ponsky (clinical) [Ep 4 · 19:08](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1148)
- The concept underlying PEG is affixing a loop of bowel to the abdominal wall and creating a permanent tract, which can be applied to various anatomic sites including stomach, jejunum, and cecum. — Jeffrey L. Ponsky (clinical) [Ep 4 · 20:53](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1253)
- Dr. Ponsky published cecostomy using the PEG technique for Ogilvie syndrome in 1984. — Jeffrey L. Ponsky (clinical) [Ep 4 · 21:16](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1276)
- SAGES membership grew from 300 members when Dr. Ponsky became president in 1990 to 2,000 members by the end of his tenure, driven by the laparoscopic cholecystectomy revolution. — Jeffrey L. Ponsky (epidemiological) [Ep 4 · 32:48](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1968)
- Jacques Perrisat showed the first video of laparoscopic cholecystectomy at the SAGES meeting in Louisville, Kentucky in 1989. — Jeffrey L. Ponsky (clinical) [Ep 4 · 32:24](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1944)
- ASGE operates as a meritocracy requiring members to work through committees (membership, governing board, treasurer) over approximately 20 years before becoming president. — Jeffrey L. Ponsky (opinion) [Ep 4 · 33:18](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1998)
- Dr. Ponsky was the second surgeon to serve as ASGE president, after Ted Schrock. — Jeffrey L. Ponsky (clinical) [Ep 4 · 34:02](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2042)
- The Schindler Award from ASGE in 2002 was the most prestigious award in Dr. Ponsky's career because it represented recognition by gastroenterologists as an endoscopist who made significant contributions. — Jeffrey L. Ponsky (opinion) [Ep 4 · 34:11](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2051)
- The concept of NOTES originated from a laparoscopic surgeon performing needlescopic cholecystectomy who removed the gallbladder through a gastrotomy, though this was never published. — Jeffrey L. Ponsky (clinical) [Ep 4 · 36:23](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2183)
- Tony Kalloo and Sergei Kantsevoy at Johns Hopkins published animal cases of transgastric surgery using the Eagle Claw device with the Apollo Group in 2004. — Jeffrey L. Ponsky (clinical) [Ep 4 · 37:03](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2223)
- Reddy and Rao in India performed the first transgastric appendectomy and showed the video but never published the work. — Jeffrey L. Ponsky (clinical) [Ep 4 · 37:23](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2243)
- NOSCAR (Natural Orifice Surgery Consortium for Assessment and Research) was formed by surgeons and gastroenterologists doing NOTES research, with the acronym conceived by Nathaniel Soper over wine. — Jeffrey L. Ponsky (clinical) [Ep 4 · 38:24](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2304)
- PEG rescue—accessing the peritoneal cavity through a dislodged PEG tract to place a new tube—was the first NOTES procedure performed in humans in the United States under IRB protocol. — Jeffrey L. Ponsky (clinical) [Ep 4 · 38:50](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2330)
- POEM (peroral endoscopic myotomy) was first performed in humans by Haruhiro Inoue in Yokohama around 2007, though the tunneling concept was conceived earlier at IRCAD in France during the NOTES era. — Jeffrey L. Ponsky (clinical) [Ep 4 · 53:24](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3204)
- Eric Hungness at Northwestern taught Dr. Ponsky and Jeff Marks the POEM technique in the lab, then proctored their first 2 human cases approximately 7 years ago (circa 2012). — Jeffrey L. Ponsky (clinical) [Ep 4 · 54:17](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3257)
- Patients undergoing POEM report life-changing improvement, with many stating 'you changed my life' at follow-up. — Jeffrey L. Ponsky (clinical) [Ep 4 · 54:42](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3282)
- Peroral pyloromyotomy (POP) via a lesser-curve tunnel 25 cm in length has been performed in over 300 cases at Cleveland Clinic. — Jeffrey L. Ponsky (clinical) [Ep 4 · 55:15](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3315)
- Two-thirds to three-quarters of patients undergoing POP show improved or normalized gastric emptying. — Jeffrey L. Ponsky (clinical) [Ep 4 · 55:37](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3337)
- POP is essentially an outpatient procedure that does not cause significant harm. — Jeffrey L. Ponsky (clinical) [Ep 4 · 55:45](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3345)
- Intramural tunneling can be used to resect stromal tumors and leiomyomas of the esophagus and stomach. — Jeffrey L. Ponsky (clinical) [Ep 4 · 55:49](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3349)
- Zenker's diverticulotomy using a double-sided submucosal tunnel approach allows complete myotomy with mucosal closure using clips, enabling same-day discharge. — Jeffrey L. Ponsky (clinical) [Ep 4 · 56:22](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3382)
- Robotic endoscopic platforms will enable surgical techniques including tissue manipulation, knot-tying, and full-thickness resection from a console, similar to robotic surgery. — Jeffrey L. Ponsky (opinion) [Ep 4 · 57:21](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3441)
- A step trocar (radially expanding surgical trocar) can be used through a PEG tract to place a large-bore gastrostomy tube when the esophagus is too stenotic to allow standard PEG tube passage. — Jeffrey L. Ponsky (clinical) [Ep 4 · 58:45](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3525)
- Surgeons interested in making endoscopy a major part of their career should complete a fellowship in advanced endoscopy to ensure their credentials cannot be challenged. — Jeffrey L. Ponsky (opinion) [Ep 4 · 61:00](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3660)
- At age 72, Dr. Ponsky performs approximately 1,200 endoscopies annually at Cleveland Clinic, working at multiple sites including monthly trips to Florida. — Jeffrey L. Ponsky (clinical) [Ep 4 · 51:15](https://library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3075)
- The interview is a small part of the whole process of selecting people for residency. — Jeffrey Ponsky (opinion) [Ep 6 · 0:21](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=21)
- Residency programs want candidates with bright eyes and full hearts, meaning desire and enthusiasm. — Jeffrey Ponsky (opinion) [Ep 6 · 0:29](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=29)
- Candidates must have passed their USMLE and have good letters of recommendation as baseline requirements. — Jeffrey Ponsky (guideline) [Ep 6 · 0:46](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=46)
- Asking people who will write bad letters of recommendation to write for you is an intelligence test that many candidates fail. — Jeffrey Ponsky (opinion) [Ep 6 · 0:52](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=52)
- During interviews, candidates should make eye contact and look interested in what the interviewer is doing. — Jeffrey Ponsky (guideline) [Ep 6 · 1:08](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=68)
- Residency programs want a partner in the education process. — Jeffrey Ponsky (opinion) [Ep 6 · 1:21](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=81)
- Interviewers want to know that candidates are willing to invest in their own education. — Jeffrey Ponsky (opinion) [Ep 6 · 1:37](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=97)
- Candidates should give interviewers a plan and vision for their future during the interview. — Jeffrey Ponsky (guideline) [Ep 6 · 1:42](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=102)
- An enthusiastic, engaged candidate can overcome merely adequate grades in the selection process. — Jeffrey Ponsky (opinion) [Ep 6 · 1:58](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=118)
- During interviews, candidates should not be shy but also should not be a jerk. — Jeffrey Ponsky (guideline) [Ep 6 · 2:09](https://library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=129)
- Medical truth is based on what tools we have to perceive it with—when we have new tools to perceive truth, our idea of what the truth is changes. — Jeffrey Ponsky (opinion) [Ep 2 · 9:12](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=552)
- 120 years ago at Johns Hopkins, medical education focused heavily on anatomy because physicians lacked knowledge of the Krebs cycle, cytochrome system, blood transfusion, blood typing, antibiotics, and pharmacology. — Jeffrey Ponsky (clinical) [Ep 2 · 10:51](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=651)
- In 1889, William Osler and William Halsted believed gastric acid caused peptic ulcer disease. — Jeffrey Ponsky (clinical) [Ep 2 · 13:07](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=787)
- H. pylori was discovered in 1990 as a cause of peptic ulcer disease; it blocks production of prostaglandin E3, destroying the mucosal barrier and allowing acid to cause ulcers. — Jeffrey Ponsky (clinical) [Ep 2 · 13:32](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=812)
- Gastrojejunostomy was the first operation for peptic ulcer disease, designed to rapidly drain gastric acid from the stomach, but it failed with a 50% recurrence rate due to marginal ulcers developing in unbuffered small bowel. — Jeffrey Ponsky (clinical) [Ep 2 · 16:15](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=975)
- Subtotal gastrectomy (removing 80% of the stomach) had a 99% success rate in preventing ulcers because it removed the parietal cells that produce acid. — Jeffrey Ponsky (clinical) [Ep 2 · 18:32](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1112)
- Subtotal gastrectomy had high mortality due to lack of intensive care units, IV fluids, and antibiotics; survivors often suffered malnutrition (inanition) severe enough to cause death. — Jeffrey Ponsky (clinical) [Ep 2 · 19:01](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1141)
- Approximately 15% of patients after subtotal gastrectomy developed dumping syndrome with severe cramps, sweating, hypotension, and diarrhea. — Jeffrey Ponsky (epidemiological) [Ep 2 · 19:38](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1178)
- Early dumping syndrome (20 minutes to 2 hours post-meal) is caused by inappropriate release of vasoactive intestinal polypeptide (VIP) from the pancreas, not by hypertonic fluid dumping into the small bowel as originally thought. — Jeffrey Ponsky (clinical) [Ep 2 · 19:52](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1192)
- Late dumping syndrome (2-4 hours post-meal) results from insulin-glucose imbalance: the intestine releases gastric inhibitory polypeptide (GIP) which stimulates pancreatic insulin release disproportionate to glucose absorption, causing insulin shock with hypoglycemia, hypotension, and tachycardia. — Jeffrey Ponsky (clinical) [Ep 2 · 21:05](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1265)
- The subtotal gastrectomy operation was later adapted as the basis for gastric bypass surgery in bariatric treatment of morbid obesity, born out of the observation that the operation caused significant weight loss. — Jeffrey Ponsky (clinical) [Ep 2 · 22:58](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1378)
- Pavlov discovered the phases of digestion; the cephalic phase occurs when sight or smell of food stimulates the vagus nerve via the area postrema of the fourth ventricle, causing salivation and gastric acid secretion. — Jeffrey Ponsky (clinical) [Ep 2 · 24:00](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1440)
- The gastric phase of digestion occurs when food distends the stomach, buffers acid (raising pH), and peptones stimulate G cells in the antrum to secrete gastrin, a heptadecapeptide (17 amino acids) that stimulates parietal cell H2 receptors to produce acid. — Jeffrey Ponsky (clinical) [Ep 2 · 25:34](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1534)
- Lester Dragstedt designed truncal vagotomy to ablate the cephalic phase of digestion by cutting both vagus nerves, but this caused the stomach to become atonic and unable to empty, requiring addition of a drainage procedure (gastrojejunostomy or pyloroplasty). — Jeffrey Ponsky (clinical) [Ep 2 · 26:48](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1608)
- Truncal vagotomy with drainage had a 15% recurrence rate for peptic ulcer disease. — Jeffrey Ponsky (epidemiological) [Ep 2 · 28:56](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1736)
- Complications of truncal vagotomy included severe diarrhea from denervating the celiac plexus, gallstones from denervating the liver, and dumping syndrome (15% of patients) from bypassing or destroying the pylorus. — Jeffrey Ponsky (clinical) [Ep 2 · 29:13](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1753)
- Antrectomy (removing the lower 40% of stomach containing G cells) combined with truncal vagotomy ablates both cephalic and gastric phases of digestion, achieving a 98% cure rate (2% recurrence) for peptic ulcer disease. — Jeffrey Ponsky (clinical) [Ep 2 · 30:10](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1810)
- Antrectomy with truncal vagotomy still caused dumping in 15% of patients and diarrhea in some patients. — Jeffrey Ponsky (epidemiological) [Ep 2 · 31:29](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1889)
- Selective vagotomy preserves the celiac and hepatic vagal branches while denervating only the stomach, reducing complications of gallstones and diarrhea while maintaining a 15% recurrence rate. — Jeffrey Ponsky (clinical) [Ep 2 · 32:38](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1958)
- The nerve of Latarjet, described by a French anatomist 100 years ago, is the terminal vagal branch that provides motor function to the pylorus but does not stimulate acid production because it innervates the antrum, which lacks parietal cells. — Jeffrey Ponsky (clinical) [Ep 2 · 34:01](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2041)
- Highly selective vagotomy denervates the acid-producing portion of the stomach while preserving the nerve of Latarjet, eliminating the cephalic phase of acid secretion while maintaining pyloric motor function, thus avoiding the need for drainage procedures and reducing dumping syndrome. — Jeffrey Ponsky (clinical) [Ep 2 · 35:17](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2117)
- Highly selective vagotomy represents a synthesis of old anatomic knowledge (histology of parietal cell distribution, nerve of Latarjet anatomy) with modern physiology and endocrinology. — Jeffrey Ponsky (opinion) [Ep 2 · 35:42](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2142)
- Surgery for peptic ulcer disease is now indicated only for complications: hemorrhage, obstruction, perforation, and intractability, the same indications as 120 years ago. — Jeffrey Ponsky (guideline) [Ep 2 · 37:48](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2268)
- Modern surgical practice for peptic ulcer obstruction involves pyloroplasty combined with H. pylori treatment and proton pump inhibitors rather than vagotomy, reflecting evolution of treatment approaches. — Jeffrey Ponsky (clinical) [Ep 2 · 38:58](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2338)
- Discovery favors the prepared mind—knowing old information (anatomy, physiology, endocrinology) enables physicians to design new approaches by recombining old and new knowledge. — Jeffrey Ponsky (opinion) [Ep 2 · 37:07](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2227)
- Students who actively participate and risk being wrong during teaching sessions retain information better than passive observers because emotional investment (anxiety, satisfaction) enhances memory consolidation. — Jeffrey Ponsky (opinion) [Ep 2 · 44:04](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2644)
- In earlier days, separate individual ports provided more functionality and flexibility than multi-hole platforms for single-port surgery. (opinion) [Ep 10 · 1:08](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=68)
- Current multi-hole platforms have improved functionality compared to earlier versions. (clinical) [Ep 10 · 1:25](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=85)
- Multiple puncture holes in fascia was a concern with separate trocar approaches. (clinical) [Ep 10 · 1:34](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=94)
- Most current multi-hole platforms have a skin barrier protector sleeve and require only one fascial incision. (clinical) [Ep 10 · 1:39](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=99)
- The mass population is probably not going to adopt the robot for single-site surgery. (opinion) [Ep 10 · 2:00](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=120)
- Different types of myotomy for achalasia have been tried, starting from the Heller one, circular or spiral. — Silvanna (clinical) [Ep 10 · 2:23](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=143)
- Myotomies that kept both longitudinal and circular layers leaving only mucosa had complications such as outpouching. — Silvanna (clinical) [Ep 10 · 2:23](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=143)
- Cutting just the circular layer provides length but may cause dilation problems because only mucosa remains without muscular support. — Silvanna (clinical) [Ep 10 · 2:44](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=164)
- In animal model testing with stretching technique, total circular myotomy provides length but the esophagus loses strength. — Silvanna (clinical) [Ep 10 · 3:09](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=189)
- Bilateral myotomy is capable of elongating the esophagus while keeping good compliance. — Silvanna (clinical) [Ep 10 · 3:09](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=189)
- Magnets are very difficult to control their force and energy once used. — Romero (clinical) [Ep 10 · 4:08](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=248)
- 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. — Brian (opinion) [Ep 10 · 4:21](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=261)
- 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. — Brian (clinical) [Ep 10 · 4:38](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=278)
- LINX developers seem to have figured out how to place it without erosions. — Brian (clinical) [Ep 10 · 4:52](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=292)
- 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. — Brian (opinion) [Ep 10 · 5:31](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=331)
- It is not clear whether radiofrequency ablation is necessary for non-dysplastic Barrett's esophagus in some people's minds. — Brian (opinion) [Ep 10 · 5:51](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=351)
- Data supporting radiofrequency ablation for non-dysplastic Barrett's will be coming down the road, though it takes a long time to generate. — Brian (opinion) [Ep 10 · 5:59](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=359)
- In the New England Journal of Medicine study, there was a significant rate of buried glands in both radiofrequency ablation and control groups. — Brian (clinical) [Ep 10 · 6:27](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=387)
- 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. — Brian (clinical) [Ep 10 · 6:36](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=396)
- Buried glands are starting to be understood as a natural state of Barrett's esophagus. — Brian (clinical) [Ep 10 · 6:53](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=413)
- Radiofrequency ablation definitely decreases buried glands and does so more than acid suppression and placebo. — Brian (clinical) [Ep 10 · 7:12](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=432)
- 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. — Samuel (clinical) [Ep 10 · 8:07](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=487)
- Common bile duct exploration is done transcystically if possible, or by choledochotomy via regular laparoscopy if not. — Samuel (clinical) [Ep 10 · 8:27](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=507)
- In a review of 500 ERCPs from 10 different endoscopists, only 68% were able to clear the biliary tree. — Samuel (clinical) [Ep 10 · 8:58](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=538)
- In many Latin American countries, an endoscopist performs 100 ERCP cases over 10 years, not as everyday routine. — Samuel (epidemiological) [Ep 10 · 9:42](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=582)
- Gastric leaks and biliary leaks have very common closure rates and usually close in about 2 to 3 weeks. (clinical) [Ep 10 · 11:08](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=668)
- 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. (clinical) [Ep 10 · 11:26](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=686)
- Chronic fistulas, especially tracheoesophageal fistulas managed for months through drainage, clips, and glues, require stents for much longer periods and have lower success rates. (clinical) [Ep 10 · 11:33](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=693)
- 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. (clinical) [Ep 10 · 12:02](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=722)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Dr. Ponsky served as director and chair of the American Board of Surgery, president of both ASGE and SAGES, and vice president of the American Surgical Association and SSAT. — The host summarizes what Dr. Jeffrey L. Ponsky said [Ep 3 · 14:36](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=876)
- Ponsky's impact on surgical endoscopy has been foundational through academic advancement of technology and technique, mentorship, and leadership in professional organizations (ASGE, SAGES) to unite gastroenterology and surgery for patient benefit. — The host summarizes what Dr. Jeffrey L. Ponsky said [Ep 3 · 11:19](https://library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=679)
- Endoscopy training became a requirement for surgical residents during Jeff Ponsky's tenure at the American Board of Surgery. — Steve summarizes what Dr. Jeff Ponsky said [Ep 1 · 4:03](https://library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=243)
- The PEG tube (percutaneous endoscopic gastrostomy) enables feeding without oral ingestion and can be life-saving for cancer patients undergoing chemotherapy by preventing anorexia, cachexia, and death. — Jolene Espinoza summarizes what Dr. Jeffrey Ponsky said [Ep 2 · 2:23](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=143)
- Dr. Jeffrey Ponsky invented the PEG tube and did not patent the invention. — Jolene Espinoza summarizes what Dr. Jeffrey Ponsky said [Ep 2 · 1:46](https://library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=106)
- To achieve 85% success in cannulating and working the biliary tree, at least 100 ERCP cases are needed on average. — Samuel summarizing the discussion [Ep 10 · 9:23](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=563)
- 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. — Samuel summarizing the discussion [Ep 10 · 9:42](https://library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-approaches-13727?t=582)

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