So why not continuing with cold?

Yeah, well, we have done that study and cold is definitely very safe.

So it reduces the breeding risk to around 2%, which is the main complication.

And if you don't do avulsion, then there's no risk of perforation either, which is also a huge advantage.

The downside is recurrence, which is around 20% and is related to size as the size of the lesion goes up.

So we know that from the hot snare data, you know, that the risk of recurrence is overall around 15%.

And if we do hot SNARE and then we do thermal ablation of the margin, we show that you can reduce recurrence to around 2%.

hope it's not what you fear.

And forward viewing, side viewing, papilla involvement?

Yeah.

So this lesion here.

So if you look at the...

the duodenum, you see, so if you have the scope straight, so normally you go around to the second part, pull back, straighten everything out.

And then, so here we have the posterior walls at six o'clock, medial wall where the papilla is at nine o'clock, lateral wall at three o'clock and anterior wall at 12 o'clock.

So with most duodenal adenomas are either on the posterior wall or lateral wall.

Are you more strict with aspirin and NOACs?

I'm not convinced, but you have to

convince me.

I knew I would.

And nothing's more enjoyable.

But I think exactly what you say is correct.

So...

In the past, we didn't have reliable tissue closure.

Sometimes there are several final cuts, honestly.

Dr. Michael Burke, the former chief psychologist for the US Marshal Service, has spent most of his career working with two kinds of people: child abuse perpetrators and the police officers who investigate their crimes.

It is probably one of the most psychologically challenging domains to enter as an investigator, and it's extremely hard to put that down and turn the lights out and lock the door and go home.

It's a, it's a very draining, very difficult aspect of law enforcement.

What do you need? What, what does it take to be one of those guys?

We're still learning, unfortunately, the hard way, uh, about what it takes to be a child abuse investigator, a child exploitation investigator.

They all have their challenges.

The folks that are working online are really, uh, pickled in depravity, and they are putting themselves in the mind of the offender in a way that other detectives and agents don't have to do.

They are being evil.