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Takahashi K, Iwama T, Muto M, Tanaka K, Kobayashi Y, Ando K, Kashima S, Ueno N, Moriichi K, Tanabe H, Harada K, Teramoto T, Fujiya M. Oral Breathing Facilitates Endoscopic Operability Compared With Nasal Breathing in Peroral Endoscopy: A Randomized Controlled Trial. Am J Gastroenterol 2024:00000434-990000000-01299. [PMID: 39162703 DOI: 10.14309/ajg.0000000000003040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/30/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Unsedated peroral endoscopy, including ultrathin endoscopy (UE) and conventional endoscopy (CE), is feasible in clinical practice but requires improved endoscopic operability and patient tolerance. Currently, the impact of the breathing method on these factors remains unclear. We conducted the first randomized controlled trial comparing oral breathing (OB) and nasal breathing (NB) during both UE and CE to assess their influence. METHODS About 252 eligible patients undergoing CE or UE were randomly assigned to OB or NB groups. Endoscopists and patients rated endoscopic operability and patient tolerance using a 100-mm visual analog scale. Visibility from the oral cavity to the middle pharynx was recorded. RESULTS OB led to a higher rate of improved visibility from the oral cavity to the middle pharynx compared with NB, ranging from 79.3% to 81.0%. Multivariate correlation analyses showed significantly lower visual analog scale scores for endoscopic operability with OB compared with NB in both UE and CE groups ( P < 0.05). No significant differences were found in the overall evaluation of patient tolerance between OB and NB groups in UE and CE, whereas the smaller diameter of UE exhibited better patient tolerance compared with CE. Discriminant analysis comparing endoscope types and breathing methods revealed that UE with OB outperformed other combinations in the overall evaluation of endoscopic operability and patient tolerance ( P < 0.05). DISCUSSION OB facilitates endoscopic operability compared with NB in peroral endoscopy. UE with OB is recommended as the preferred choice for unsedated peroral endoscopy in daily practice.
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Affiliation(s)
- Keitaro Takahashi
- Department of Internal Medicine, Division of Gastroenterology, Asahikawa Medical University, Asahikawa, Japan
| | - Takuya Iwama
- Department of Gastroenterology, Asahikawa City Hospital, Asahikawa, Japan
| | - Momotaro Muto
- Department of Internal Medicine, Engaru-Kosei General Hospital, Engaru, Japan
| | - Kazuyuki Tanaka
- Department of Gastroenterology, Asahikawa-Kosei General Hospital, Asahikawa, Japan
| | - Yu Kobayashi
- Department of Internal Medicine, Division of Gastroenterology, Asahikawa Medical University, Asahikawa, Japan
| | - Katsuyoshi Ando
- Department of Internal Medicine, Division of Gastroenterology, Asahikawa Medical University, Asahikawa, Japan
| | - Shin Kashima
- Department of Internal Medicine, Division of Gastroenterology, Asahikawa Medical University, Asahikawa, Japan
| | - Nobuhiro Ueno
- Department of Internal Medicine, Division of Gastroenterology, Asahikawa Medical University, Asahikawa, Japan
| | - Kentaro Moriichi
- Department of Internal Medicine, Division of Gastroenterology, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroki Tanabe
- Department of Internal Medicine, Division of Gastroenterology, Asahikawa Medical University, Asahikawa, Japan
| | | | - Takashi Teramoto
- Department of Data Science, Kyoto Women's University, Kyoto, Japan
| | - Mikihiro Fujiya
- Department of Internal Medicine, Division of Gastroenterology, Asahikawa Medical University, Asahikawa, Japan
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Oh DJ, Lee YJ, Kim SH, Chung J, Lee HS, Nam JH, Lim YJ. Efficacy and safety of three-dimensional magnetically assisted capsule endoscopy for upper gastrointestinal and small bowel examination. PLoS One 2024; 19:e0295774. [PMID: 38713694 DOI: 10.1371/journal.pone.0295774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/27/2023] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Magnetically assisted capsule endoscopy (MACE) showed the feasibility for upper gastrointestinal examination. To further enhance the performance of conventional MACE, it is necessary to provide quality-improved and three-dimensional images. The aim of this clinical study was to determine the efficacy and safety of novel three-dimensional MACE (3D MACE) for upper gastrointestinal and small bowel examination at once. METHODS This was a prospective, single-center, non-randomized, and sequential examination study (KCT0007114) at Dongguk University Ilsan Hospital. Adult patients who visited for upper endoscopy were included. The study protocol was conducted in two stages. First, upper gastrointestinal examination was performed using 3D MACE, and a continuous small bowel examination was performed by conventional method of capsule endoscopy. Two hours later, an upper endoscopy was performed for comparison with 3D MACE examination. The primary outcome was confirmation of major gastric structures (esophagogastric junction, cardia/fundus, body, angle, antrum, and pylorus). Secondary outcomes were confirmation of esophagus and duodenal bulb, accuracy for gastric lesions, completion of small bowel examination, 3D image reconstruction of gastric lesion, and safety. RESULTS Fifty-five patients were finally enrolled. The examination time of 3D MACE was 14.84 ± 3.02 minutes and upper endoscopy was 5.22 ± 2.39 minutes. The confirmation rate of the six major gastric structures was 98.6% in 3D MACE and 100% in upper endoscopy. Gastric lesions were identified in 43 patients during 3D MACE, and 40 patients during upper endoscopy (Sensitivity 0.97). 3D reconstructed images were acquired for all lesions inspected by 3D MACE. The continuous small bowel examination by 3D MACE was completed in 94.5%. 3D MACE showed better overall satisfaction (3D MACE 9.55 ± 0.79 and upper endoscopy 7.75 ± 2.34, p<0.0001). There were no aspiration or significant adverse event or capsule retention in the 3D MACE examination. CONCLUSIONS Novel 3D MACE system is more advanced diagnostic modality than the conventional MACE. And it is possible to perform serial upper gastrointestinal and small bowel examination as a non-invasive and one-step test. It would be also served as a bridge to pan-endoscopy.
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Affiliation(s)
- Dong Jun Oh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Yea Je Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Sang Hoon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Joowon Chung
- Department of Internal Medicine, Nowon Eulji Medical Center, Seoul, Republic of Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Dong L, Zhang X, Xuan Y, Xiong P, Ning Y, Zhang B, Wang F, Zhao Q, Fang J. Relationship between observation time and detection rate of focal lesions in Esophagogastroduodenoscopy: a single-center, retrospective study. BMC Gastroenterol 2024; 24:75. [PMID: 38360548 PMCID: PMC10870502 DOI: 10.1186/s12876-024-03157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Current studies have shown that longer observation time can improve neoplastic detection rate. This study aimed to clarify whether endoscopists with longer observation times can detect more focal lesions. METHODS Based on the mean examination time for Esophagogastroduodenoscopy (EGD) without biopsy, endoscopists were divided into fast and slow groups, and the detection rate of focal lesions was compared between the two groups. Univariate analysis, multivariate analysis and restricted cubic spline were used to explore the factors of focal lesion detection rate. RESULTS Mean examination time of EGD without biopsy was 4.5 min. The cut-off times used were 5 min. 17 endoscopists were classified into the fast (4.7 ± 3.6 min), and 16 into the slow (7.11 ± 4.6 min) groups. Compared with fast endoscopists, slow endoscopists had a higher detection rate of focal lesions (47.2% vs. 51.4%, P < 0.001), especially in the detection of gastric lesions (29.7% vs. 35.9%, P < 0.001). In univariate and multivariate analyses, observation time, patient age and gender, expert, biopsy rate, and number of images were factors in FDR. There is a nonlinear relationship between observation time and FDR. CONCLUSION Longer examination time improves the detection rate of focal lesions. Observation time is an important quality indicator of the EGD examination.
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Affiliation(s)
- Li Dong
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, 169 Donghu-ro, Wuchang-gu, 430071, Wuhan, China
| | - Xiaodan Zhang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, 169 Donghu-ro, Wuchang-gu, 430071, Wuhan, China
| | - Yuting Xuan
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, 169 Donghu-ro, Wuchang-gu, 430071, Wuhan, China
| | - Peiling Xiong
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, 169 Donghu-ro, Wuchang-gu, 430071, Wuhan, China
| | - Yumei Ning
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, 169 Donghu-ro, Wuchang-gu, 430071, Wuhan, China
| | - Bing Zhang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, 169 Donghu-ro, Wuchang-gu, 430071, Wuhan, China
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, 169 Donghu-ro, Wuchang-gu, 430071, Wuhan, China.
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, 169 Donghu-ro, Wuchang-gu, 430071, Wuhan, China.
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Patra BR, Harindranath S, Ansari AA, Gupta S, Saner C, Pujalwar S, Vaidya A, Singh A, Aggarwal M, Shukla A. Utility of gastroscopy in the left lateral semi-recumbent position: A blood-free coup! Endosc Int Open 2023; 11:E1168-E1174. [PMID: 38094029 PMCID: PMC10715906 DOI: 10.1055/a-2202-8050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/27/2023] [Indexed: 01/10/2024] Open
Abstract
Background and study aims The utility of esophagogastroduodenoscopy (EGD) in the left lateral semi-recumbent position in the setting of acute upper gastrointestinal bleeding (UGIB) with a persistent fundal pool of blood for adequate visualization and effective endotherapy has not been studied. This study aimed to evaluate the feasibility, efficacy, and safety of this position in such settings. Patients and methods A prospective study of patients presenting with acute UGIB with an uncleared fundal pool of blood was conducted. All underwent EGD in the left lateral decubitus and secondary left lateral semi-recumbent positions. Outcomes in secondary position in terms of adequate visualization of the fundus, identification of new or additional sources of bleeding, and effectiveness of endotherapy were studied. Results We screened 860 patients and included 44 patients (5.11%) with a persistent fundal pool of blood. Endoscopy in the primary position revealed the source of bleeding in 37 of 44 patients (84%). The source of the bleeding was not identified in seven of 44 patients (16%). Endoscopy in the secondary position showed clearance of fundal pool in all 44 patients (100%). A new source of bleeding was identified in all seven patients (100%) and an additional source could be identified in another five patients (13.6%). Endotherapy was performed in the secondary position for all 44 patients with 100% technical success and 94% clinical success. Conclusions These data show that endotherapy in the left lateral semi-recumbent position is feasible, safe, and effective. It should be done when endoscopy in the left lateral decubitus position reveals a pool of blood in the fundus and there is inadequate visualization of the fundus.
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Affiliation(s)
- Biswa Ranjan Patra
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Abu Aasim Ansari
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shubham Gupta
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Chetan Saner
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shashank Pujalwar
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Arun Vaidya
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Ankita Singh
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Mohit Aggarwal
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Guo HM, Sun Y, Cai S, Miao F, Zheng Y, Yu Y, Zhao ZF, Liu L. A novel technique for endoscope progression in gastroscopy resection: forward-return way for dissection of stromal tumor in the muscularis propria of the gastric fundus. Front Oncol 2023; 13:1077201. [PMID: 37274232 PMCID: PMC10233095 DOI: 10.3389/fonc.2023.1077201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Background The fundus of the stomach is a challenging region for endoscopic resection of gastrointestinal stromal tumors (GISTs), especially in the anterior wall of the fornix at the side of the greater curvature. This study aimed to introduce the Forward-Return Way (FRW) technique in gastric fundus operations and provide evidence of its advantages. The FRW technique allows the gastroscope to access the stomach fornix without entering the gastric antrum after passing through the gastric cardia. Using FRW, the gastroscope body makes a forward return along the wall of the posterior wall of the upper gastric body and the wall of the greater curvature. Methods The clinical data of patients with stromal tumors in muscularis propria at the gastric fundus (STMF) at the Fourth Hospital of China Medical University between May 2020- March 2021 were reviewed. The novel FRW technique was used in the procedures, and the beneficial effects, suitability, applicable lesion site, and success rates of FRW were analyzed. Results A total of 10 cases were reviewed, and the FRW technique was successfully performed in 7 cases (70%). The gastroscope's tip reached the area just below the gastric cardia, allowing endoscopists to successfully access all angles and sites of the stomach's fundus in all seven patients. The lesion was easily accessed, and the gastroscope was stable with good left-right and forward-backwards movements. Conclusion The FRW technique significantly facilitates the resection of the GISTs by aligning the endoscopy body movement direction with the observation direction. Gastrointestinal Stromal Tumor; forward-return of gastroscopy along the gastric body wall; muscularis propria; gastric fundus.
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Khorasani M, Abdurahiman N, Padhan J, Zhao H, Al-Ansari A, Becker AT, Navkar N. Preliminary design and evaluation of a generic surgical scope adapter. Int J Med Robot 2023; 19:e2475. [PMID: 36288569 DOI: 10.1002/rcs.2475] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/21/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Robotic scope assistant systems are used to visualise and navigate the operative field during a laparoscopic surgery. The objective of this work is to design a surgical scope adapter that enables control of different scope types (zero-degree, angulated, and articulated), and can be connected to any six degree-of-freedom robotic manipulator for usage as a robotic scope assistant system. METHODS A surgical scope adapter compatible with different camera heads and scope types was designed and prototyped. The technical performance of the scope adapter was evaluated and a user study was conducted to assess the human-in-the-loop control. RESULTS All the subjects were able to navigate the simulated operative field. The scope adapter permits continuous motion to explore the operative field as well as intermittent motion to accurately focus on the targeted anatomical landmarks. CONCLUSION The modular and generic nature of the surgical scope adapter may enable its usage across different minimally invasive surgeries.
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Affiliation(s)
| | | | | | - Haoran Zhao
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | | | - Aaron T Becker
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Nikhil Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Sivananthan A, Kerry G, Darzi A, Patel K, Patel N. Orientation in upper gastrointestinal endoscopy—the only way is up. World J Gastrointest Endosc 2023; 15:146-152. [PMID: 37034971 PMCID: PMC10080556 DOI: 10.4253/wjge.v15.i3.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/15/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Oesophagogastroduodenoscopy is the gold standard investigation for the upper gastrointestinal (UGI) tract. Orientation during endoscopy is challenging and United Kingdom training focusses on technical competence and procedural safety. The reported location of UGI pathologies is crucial to post-endoscopic planning.
AIM To evaluate endoscopists’ ability to spatially orientate themselves within the UGI tract.
METHODS A cross sectional descriptive study elicited, using an anonymised survey, the ability of endoscopists to orientate themselves within the UGI tract. The primary outcome was percentage of correct answers from all surveyed; secondary outcomes were percentage of correct answers from experienced vs novice endoscopists. Pearson’s χ2 test was applied to compare groups.
RESULTS Of 188 respondents, 86 were experienced endoscopists having completed over 1000 endoscopies. 44.4% of respondents correctly identified the anterior stomach and 47.3% correctly identified the posterior of the second part of the duodenum (D2). Experienced endoscopists were significantly more likely than novice to identify the anterior stomach correctly [61.6% vs 31.3%, X2 (1, n = 188) = 11.10, P = 0.001]. There was no significant difference between the two groups in identifying the posterior of D2.
CONCLUSION The majority of endoscopists surveyed were unable to identify key landmarks within the UGI tract. Endoscopic orientation appears to improve with experience yet there are some areas still not well recognised. This has potential considerable impact on post-endoscopic management of patients with posterior duodenal ulcers being more likely to perforate and associated with a higher rebleeding risk. We suggest the development of a consensus statement on endoscopic description.
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Affiliation(s)
- Arun Sivananthan
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Georgina Kerry
- Liver Intensive Care Unit, King’s College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Kinesh Patel
- Gastroenterology, Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, United Kingdom
| | - Nisha Patel
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
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Yang CW, Chu YH, Chen HC, Huang WC, Chen PJ, Chang WK. Gastrointestinal Endoscopy Performed by Gastroenterologists: Opportunistic Screening Strategy for Newly Diagnosed Head and Neck Cancers. Front Oncol 2022; 12:793318. [PMID: 35692778 PMCID: PMC9185840 DOI: 10.3389/fonc.2022.793318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Approximately 66% of head and neck cancers are diagnosed at an advanced stage. This prospective study aimed to detect newly diagnosed head and neck cancers using regular upper gastrointestinal (UGI) endoscopy with oral-pharynx-larynx examination. Methods A total of 2,849 patients underwent UGI endoscopy with an additional oral-pharynx-larynx examination. Patients aged < 20 years, those who were pregnant, had a history of head and neck cancers, were undergoing emergency endoscopy, and had a poor laryngopharyngeal view were excluded. The symptoms, incidence, location, pathology, and stage of malignant neoplasms were investigated. Results A total of 2,720 patients were enrolled. Endoscopically observable 23 abnormal findings (0.85%) included 18 (0.66%) benign lesions and 5 (0.18%) newly diagnosed malignant neoplasms. Notably, 4 (80%) of 5 patients with malignant neoplasms were diagnosed at an early stage (Stage 0, I, and II). Conclusions UGI endoscopy with oral-pharynx-larynx examination can achieve opportunistic head neck cancer screening and is recommended for every patient in endoscopy units.
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Affiliation(s)
- Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yueng-Hsiang Chu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chen Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Aryan M, Jariwala R, Alkurdi B, Peter S, Shoreibah M. The misclassification of gastric antral vascular ectasia. J Clin Transl Res 2022; 8:218-223. [PMID: 35813901 PMCID: PMC9260348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Gastric antral vascular ectasia (GAVE) is characterized by angiodysplastic lesions and is a rare form of gastrointestinal bleeding. Given the multiple patterns, GAVE can be misclassified. AIM We analyzed the misclassification of GAVE among patients undergoing esophagogastroduodenoscopy (EGD). METHODS We performed a retrospective review of 941 EGDs between 2017 and 2019. Inclusion criteria included findings of GAVE on EGD±biopsy. Correct classification was based on visual EGD findings. Outcome variables included misclassification rate, endoscopist's background, and concordance between EGD and pathology. Cohen's Kappa test was used for concordance analysis. RESULTS A total of 110 patients had EGD findings of GAVE with a corresponding 184 EGDs. The misclassification rate among EGDs was 74/184 (40%). Furthermore, 81/110 patients were correctly classified with their first workup, whereas 29/110 patients needed repeat testing. In cases of misclassification, GAVE was mostly referred to as erythema (43%), with ulceration, gastritis, or polyps. Sixty-six (60%) patients had biopsies with a concordance of 76% between EGD and biopsy (κ=0.35). CONCLUSIONS Our findings indicate GAVE was misclassified up to 40% on EGDs with hepatologists and gastroenterologists having similar misclassification rates. Proper identification is crucial given susceptibility to upper gastrointestinal bleeding. RELEVANCE FOR PATIENTS This study emphasizes the importance of accurate classification of GAVE to ensure proper treatment of these lesions which can improve clinical outcomes.
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Affiliation(s)
- Mahmoud Aryan
- 1Department of Medicine, Tinsley Harrison Internal Medicine Residency, University of Alabama at Birmingham, Birmingham, Alabama, United States,Corresponding author: Mahmoud Aryan, Tinsley Harrison Internal Medicine Residency, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States. Tel.: 205-934-2490
| | - Ravi Jariwala
- 1Department of Medicine, Tinsley Harrison Internal Medicine Residency, University of Alabama at Birmingham, Birmingham, Alabama, United States,2Department of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana, United States
| | - Basem Alkurdi
- 3Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Shajan Peter
- 3Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Mohamed Shoreibah
- 3Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Charoenkoop P, Luetrakool P, Puttapornpattana T, Sangdee N. Anesthesiology trainees performing flexible scope intubation in spontaneously breathing patients in the left lateral position and the supine position: a prospective randomized trial. BMC Anesthesiol 2022; 22:93. [PMID: 35366811 PMCID: PMC8976386 DOI: 10.1186/s12871-022-01636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Flexible scope intubation is an important airway management skill that requires hands-on training in a real airway. We compared flexible scope intubation by trainees between patients in the left lateral and supine positions. Methods Forty patients aged 20 to 80 years with American Society of Anesthesiologists physical status class I to III were scheduled for elective surgery under general endotracheal anesthesia in Ramathibodi Hospital from February 2020 to June 2020. Patients were randomly assigned to be intubated in one of two positions: supine (Group S) or left lateral (Group L). Trainees performed flexible scope intubation in sedated patients under the supervision of an attending anesthesiologist. Intubation success, time to successful intubation, number of attempts, airway adjustment maneuvers, and hemodynamic changes were compared between groups. Results Patient characteristics did not differ between groups except for Mallampati airway classification. The rate of successful intubation on the first attempt and intubation time did not significantly differ between groups. The proportion of patients who required a jaw thrust during intubation was significantly lower in Group L (10.5% vs. 85%; P < 0.01). Blood pressure and oxygen saturation declined in both groups after intubation. The relative risk of desaturation in patients in the left lateral position compared with the supine position was 0.44 (0.1649–1.1978). Conclusion The rate of successful flexible scope intubation on the first attempt and intubation time did not differ between the groups. The proportion of patients who required a jaw thrust maneuver was significantly lower in patients in the left lateral position. Trial registration https://www.thaiclinicaltrials.org/ (TCTR20200208001) on 08/02/2020.
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Du H, Ning L, Chen H, Hu F, Shan G, Chen W, Xu G. Endoscopic treatment can be a viable therapeutic option for esophageal gastrointestinal stromal tumors. Scand J Gastroenterol 2022; 57:371-376. [PMID: 34839764 DOI: 10.1080/00365521.2021.2009024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Esophageal gastrointestinal stromal tumors(GISTs) are extremely rare. We sought to determine whether endoscopic treatment can be a viable therapeutic option for esophageal GISTs. METHODS A total of 20 cases with histological diagnosis of esophageal GISTs were obtained from our center between 2008 and 2020. Data on the clinicopathological features and treatment were recorded. RESULTS There were 9 males (45%) and 11 females (55%) in this study, with a median age of 56 years. The tumors preferentially occurred in the middle and lower parts of the thoracic esophagus (45 and 40%, respectively). The mean size of the tumors was 2.27 cm and mitotic index was no more than 5/50 high power field (HPF) in all patients. In this study, 11 patients received endoscopic treatment and nine patients underwent surgical resection. Tumors ranged from 0.6 to 4 cm in the endoscopic treatment patients and 0.5 to 7 cm in the surgical patients. There were no significant differences in gender, age, symptoms, tumor location, tumor size, mitotic index, and adjuvant imatinib therapy between the endoscopic treatment group and the surgery group (all p > .05). The Kaplan-Meier curve suggested that there was also no significant difference in disease-free survival between the two groups (p = .264). CONCLUSIONS Endoscopic treatment may be an option for the treatment of esophageal GISTs smaller than 5 cm with a mitotic index no more than 5/50 HPF.
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Affiliation(s)
- Haojie Du
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Longgui Ning
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongtan Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fengling Hu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guodong Shan
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenguo Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoqiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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12
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Detection of Healthy and Diseased Pylorus Natural Anatomical Center with Convolutional Neural Network Classification and Filters. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Siau K, Beales ILP, Haycock A, Alzoubaidi D, Follows R, Haidry R, Mannath J, McConnell S, Murugananthan A, Ravindran S, Riley SA, Williams RN, Trudgill NJ, Veitch AM. JAG consensus statements for training and certification in oesophagogastroduodenoscopy. Frontline Gastroenterol 2022; 13:193-205. [PMID: 35493618 PMCID: PMC8996097 DOI: 10.1136/flgastro-2021-101907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Training and quality assurance in oesophagogastroduodenoscopy (OGD) is important to ensure competent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for OGD training and certification. METHODS Under the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted with stakeholder representation from British Society of Gastroenterology, Association of Upper Gastrointestinal Surgeons, trainees and trainers. Recommendations on OGD training and certification were formulated following literature review and appraised using Grading of Recommendations Assessment, Development and Evaluation. These were subjected to electronic voting to achieve consensus. Accepted statements were incorporated into the updated certification pathway. RESULTS In total, 32 recommendation statements were generated for the following domains: definition of competence (4 statements), acquisition of competence (12 statements), assessment of competence (10 statements) and post-certification support (6 statements). The consensus process led to following certification criteria: (1) performing ≥250 hands-on procedures; (2) attending a JAG-accredited basic skills course; (3) attainment of relevant minimal performance standards defined by British Society of Gastroenterology/Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, (4) achieving physically unassisted D2 intubation and J-manoeuvre in ≥95% of recent procedures, (5) satisfactory performance in formative and summative direct observation of procedural skills assessments. CONCLUSION The JAG standards for diagnostic OGD have been updated following evidence-based consensus. These standards are intended to support training, improve competency assessment to uphold standards of practice and provide support to the newly-independent practitioner.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK,Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Adam Haycock
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Durayd Alzoubaidi
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Rehan Haidry
- Department of Gastroenterology, Division of Surgery and Interventional Science, University College London Hospital NHS Foundation Trust, London, UK
| | - Jayan Mannath
- Department of Gastroenterology, Coventry and Warwickshire NHS trust, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Susan McConnell
- Endoscopy Department, University Hospital of North Durham, Durham, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Surgery and Cancer, Imperial College London, London, UK
| | - Stuart A Riley
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - R N Williams
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nigel John Trudgill
- Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Andrew M Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK,President-Elect, British Society of Gastroenterology, London, UK
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14
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Mahawongkajit P, Techagumpuch A, Auksornchat K. Effects of basic endoscopic handling and care training on gastrointestinal endoscopy logistics. Endosc Int Open 2022; 10:E56-E61. [PMID: 35047335 PMCID: PMC8759933 DOI: 10.1055/a-1630-6403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/24/2021] [Indexed: 10/26/2022] Open
Abstract
Background and study aims The current practice of endoscopists is undergoing a dramatic revolution due to emerging endoscopy practices. Increasing use of gastrointestinal endoscopy has led to hospital budgets setting aside funds specifically related to damage to endoscopic instruments. Therefore, training in understanding endoscopic equipment, handling techniques, and equipment care can be helpful in addressing this issue. The aim of this study was to investigate the effects of educational courses and training about basic endoscopic handling and care in gastrointestinal endoscopic care and services. Methods A number of new endoscopists, nurses, and nurse assistants were enrolled in a course for training in basic endoscopic handling and care. Data on the type of damage, cause, cost, and timing of endoscopic repair were prospectively collected. Data from the post-training period then were compared with retrospective data from the pre-training period. Results This study demonstrated that after training, there was less damage to endoscopes, lower costs associated with it, and repair times were shorter for endoscopes than before the training course. Post-training results indicated savings of a total of $ 40,617.21 or £ 29,539.78 and 102.6 days per damaged endoscope. Conclusions Basic endoscopic handling and care training plays an important role for both endoscopists and nurses, as well as in endoscopy facilities, specifically in avoiding the nuisance of unwanted and broken endoscopes. This could be beneficial for both hospital finances and endoscopic services.
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Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Ajjana Techagumpuch
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Kharikarn Auksornchat
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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15
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Coskun Y, Yuksel I. One- or two-operator techniques for oesophago-gastro-duodenoscopy in unsedated patients: A comparative prospective randomized study. GASTROENTEROLOGIA Y HEPATOLOGIA 2022; 45:18-24. [PMID: 33647343 DOI: 10.1016/j.gastrohep.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The standard oesophago-gastro-duodenoscopy procedure is performed with a single endoscopist (SE). Nurse-assisted (NA) oesophago-gastro-duodenoscopies have not yet been studied. We aimed to evaluate the efficacy of an NA endoscopy compared to an SE endoscopy. METHODS A prospective, single-center, randomized trial, in which 500 adult patients were divided into two groups. In the first group, patients underwent an endoscopy with an SE. In the second group, the endoscopy was performed with an NA. The ease of the procedure (scores 1-4; 1 difficult, 2 satisfactory, 3 easy, 4 veryeasy), evaluation of patient satisfaction (scores 1-4; 1 uncomfortable, 2 satisfactory, 3 comfortable, 4 verycomfortable), total time of the procedure and vocal cord observation were determined as quality indicators. RESULTS Mean patient satisfaction scores in groups 1 and 2 were 2.98±0.79 and 3.11±0.78, respectively (p=0.043), with uncomfortable ratings in 5.2% vs 4%, satisfactory in 16.8% vs 13.2%, comfortable in 53.2% vs 50.4%, and very comfortable in 24.8% vs 32.4% of patients in groups 1 and 2, respectively. Retching rates during the procedure were 54.4% and 45.2% (p=0.040) in groups 1 and 2, respectively. No differences were seen in vocal cord observation (54.4% vs 56.0%), total procedure time (2.35±1.56 vs 2.41±1.48min) and easy score (3.26±0.603 vs 3.25±0.64) in groups 1 and 2 for the procedures. Very easy, easy, satisfactory, and difficult ratings were given by 33.6% vs 34.8%, 60.4% vs 56.4%, 4.8% vs 7.6% and 1.2% vs 1.2% of groups 1 and 2, respectively. CONCLUSIONS Compared with the conventional method, the assisted endoscopic technique provides more comfort and less gag reflex without increasing the processing time or difficulty of performing the procedure.
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Affiliation(s)
- Yusuf Coskun
- Department of Gastroenterology, University of Health Sciences, Diskapı Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Ilhami Yuksel
- Department of Gastroenterology, University of Health Sciences, Diskapı Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; Department of Gastroenterology, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
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16
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Johnson G, Vergis A, Unger B, Park J, Gillman L. Design and Validity Evidence for a Unique Endoscopy Simulator Using a Commercial Video Game. Cureus 2021; 13:e18379. [PMID: 34725623 PMCID: PMC8553393 DOI: 10.7759/cureus.18379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/05/2022] Open
Abstract
Background Procedural simulation enhances early endoscopy training. Multiple commercial simulators are available; however, their application is limited by cost and poor user compliance. First-person "shooter" (FPS) video games are popular. In this study, we aimed to show that a novel in-house designed colonoscope controller used to play an FPS video game shares similar constructs with real-life endoscopy. Methodology Participants completed the first three levels on an FPS video game, Portal (Valve Corporation, Bellevue, WA), first using a conventional controller and then the modified endoscope controller. A total of 12 expert endoscopists and 12 surgical residents with minimal endoscopy experience were evaluated based on completion time, button presses, and hand motion analyses. Results Experts outperformed novices for completion time (expert: 944 seconds; novice: 1,515 seconds; p = 0.006) and hand movements (expert: 1,263.1; novice: 2,052.6; p = 0.004) in using the novel colonoscope controller. There was no difference in button presses or total path length traveled. Furthermore, performance did not differ using conventional game controls. Conclusions Experts outperformed novices using the endoscope but not the conventional controller with respect to the economy of movement and completion time. This result confirms that our endoscope-controlled video game shares similar paradigms with real-life endoscopy and serves as a first step toward creating a more enjoyable and cheaper alternative to commercially available endoscopy simulators.
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Affiliation(s)
| | | | - Bertram Unger
- Internal Medicine, University of Manitoba, Winnipeg, CAN
| | - Jason Park
- Surgery, University of Manitoba, Winnipeg, CAN
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17
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Abu-Shaban K, Liu X, Siders B. Diffuse Cerebral Air Emboli After an Esophagogastroduodenoscopy One Month Post Left Atrial Ablation for Atrial Fibrillation. Cureus 2021; 13:e18101. [PMID: 34692312 PMCID: PMC8525678 DOI: 10.7759/cureus.18101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
We present a case of a patient who presented to the emergency department with vague abdominal pain one month after undergoing a left atrial ablation procedure for atrial fibrillation. While in the emergency department, the patient started to have episodes of hematemesis. Esophagogastroduodenoscopy (EGD) was performed and the patient become hypotensive and unresponsive after. Imaging confirmed atrioesophageal fistula and widespread cerebral air emboli and diffuse ischemia. Air emboli were likely introduced through the fistula during the EGD.
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Affiliation(s)
- Kamil Abu-Shaban
- Radiology, University of Toledo College of Medicine, Toledo, USA
| | - Xiaochen Liu
- Radiology, University of Toledo Medical Center, Toledo, USA
| | - Bruce Siders
- Radiology, University of Toledo Medical Center, Toledo, USA
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18
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Moon Y, Hyun J, Oh J, Lee K, Lee YS, Kim JK. A Wi-Fi-Based Mask-Type Laryngoscope for Telediagnosis During the COVID-19 Pandemic: Instrument Validation Study. J Med Internet Res 2021; 23:e31224. [PMID: 34518154 PMCID: PMC8525626 DOI: 10.2196/31224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background Owing to the COVID-19 pandemic, social distancing has become mandatory. Wireless endoscopy in contactless examinations promises to protect health care workers and reduce viral spread. Objective This study aimed to introduce a contactless endoscopic diagnosis system using a wireless endoscope resembling a mask. Methods The Wi-Fi–based contactless mask endoscopy system comprises a disposable endoscope and a controller. First, the effective force applied by the tip during insertion was evaluated in a simple transoral model consisting of a force sensor on a simulated oropharynx wall. Second, the delay in video streaming was evaluated by comparing the frame rate and delays between a movement and its image over direct and Wi-Fi connections. Third, the system was applied to a detailed laryngopharyngeal tract phantom. Results The smartphone-controlled wireless endoscopy system was successfully evaluated. The mean, maximum, and minimum collision forces against the wall of the transoral model were 296 mN (30 gf), 363 mN (37 gf), and 235 mN (24 gf), respectively. The delay resulting from the wireless connection was 0.72 seconds. Using the phantom, an inexperienced user took around 1 minute to orient the endoscope to a desired area via the app. Conclusions Device articulation does not pose a significant risk of laryngopharyngeal wall penetration, and latency does not significantly impede its use. Contactless wireless video streaming was successful within the access point range regardless of the presence of walls. The mask endoscope can be controlled and articulated wirelessly, minimizing contact between patients and device operators. By minimizing contact, the device can protect health care workers from infectious viruses like the coronavirus.
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Affiliation(s)
- Youngjin Moon
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.,Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaeho Hyun
- Department of Biomedical Engineering, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeongmin Oh
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Kwanhee Lee
- Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Ki Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.,Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
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19
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Design and Evaluation of a Foot-Controlled Robotic System for Endoscopic Surgery. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3062009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Khan R, Scaffidi MA, Satchwell J, Gimpaya N, Lee W, Genis S, Tham D, Saperia J, Al-Mazroui A, Walsh CM, Grover SC. Impact of a simulation-based ergonomics training curriculum on work-related musculoskeletal injury risk in colonoscopy. Gastrointest Endosc 2020; 92:1070-1080.e3. [PMID: 32205194 DOI: 10.1016/j.gie.2020.03.3754] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopists are at risk of developing musculoskeletal injuries (MSIs), and few receive training on ergonomics. The aim of this study was to determine the impact of a simulation-based ergonomics training curriculum (ETC) on work-related MSI risk during clinical colonoscopy. METHODS Novice endoscopists underwent a simulation-based ETC and were compared with an historical control group who received simulation-based training without ergonomics training. The ETC included a didactic lecture and video on ergonomics in colonoscopy, feedback from supervisors on ergonomics, and an ergonomics checklist to augment feedback and promote self-reflection. Participants were assessed using the rapid entire body assessment (REBA) and rapid upper limb assessment (RULA). The primary outcome was participants' REBA scores during 2 clinical colonoscopies 4 to 6 weeks after training. RESULTS In clinical colonoscopy, the ETC group had superior REBA scores (clinical procedure 1: median score, 6 vs 11; P < .001; clinical procedure 2: median score, 6 vs 10; P < .001). In a simulated colonoscopy, the ETC group did not have significantly different REBA or RULA scores between baseline, immediately after training, and 4 to 6 weeks after (REBA: median scores of 5, 5, and 5, respectively; P > .05; RULA: median scores of 6, 6, and 6, respectively; P > .05). The control group had worsening REBA and RULA scores during the study timeline (REBA: median scores of 5 at baseline, 9 immediately after training, and 9 at 4-6 weeks after training; P < .001; RULA: median scores of 6, 7, and 7, respectively; P = .04) during simulated procedures. CONCLUSIONS A simulation-based ETC is associated with reduced risk of MSI during endoscopy. Although the REBA score was improved, the intervention group was still within the medium-risk range.
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Affiliation(s)
- Rishad Khan
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Joshua Satchwell
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Woojin Lee
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Shai Genis
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel Tham
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - James Saperia
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ahmed Al-Mazroui
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute and Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; The Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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21
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Sugimoto K, Osawa S. 'Four-position method' makes beginner endoscopists aware of spatial positioning of the left hand to master upper gastrointestinal endoscopy. Endosc Int Open 2020; 8:E1225-E1230. [PMID: 33015323 PMCID: PMC7505699 DOI: 10.1055/a-1197-6418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background and study aims We developed a novel "four-position method" for facilitating endoscopy of the upper gastrointestinal tract, and this study aimed to verify its usefulness for beginner endoscopists. Methods Medical students (n = 121) were divided into three groups. A simulator subsequently was used to perform endoscopy. Group A was taught how to hold the endoscope and move the dial; Group B was taught the "four-position method"; and Group C, in addition to being taught the "four-position method," was permitted to use an endoscope before introduction to the simulator. In each group, the transit time to various parts of the upper digestive tract was recorded in addition to the time to grasp a clip in the stomach with the forceps. We also surveyed the groups with respect to their impression of the difficulty level of endoscopic operation before and after instructions. Results Transit time to the cardia was no different among the groups; however, with regard to other targets, Group C reached the sites significantly more quickly than did Groups A and B. Time to clip grasping was significantly shorter in Groups B and C than in Group A. Regarding the impression of the difficulty level, significantly more students in Groups B and C compared to Group A felt that endoscopy was easier after instructions. Conclusion Learning the "four-position method" made it possible to achieve stable endoscopic manipulation at an early stage and improve subsequent endoscopic procedures.
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Affiliation(s)
- Ken Sugimoto
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoshi Osawa
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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22
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Affiliation(s)
- Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Samir C Grover
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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23
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Lee JI, Kim JS, Kim BW, Huh CW. Taking More Gastroscopy Images Increases the Detection Rate of Clinically Significant Gastric Lesions: Validation of a Systematic Screening Protocol for the Stomach. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2020. [DOI: 10.7704/kjhugr.2020.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background/Aims: For systematic screening protocol for the stomach (SSS), 22 gastroscopy images are considered sufficient to avoid blind spots during gastroscopy. The aim of this study was to investigate the relationship between the number of gastroscopy images taken during the gastroscopy procedure and the detection rate of clinically significant gastric lesions (CSGLs).Materials and Methods: We retrospectively reviewed the data obtained from a cohort of consecutive subjects at a health promotion center. The primary outcome measure was the detection rate of CSGLs per endoscopist, according to the number of gastroscopy images. We also analyzed whether all the CSGLs were detected via SSS.Results: The mean number of gastroscopy images obtained by eight endoscopists was 27.6±10.5 in 2,912 subjects without CSGLs and without biopsies. Among the 5,970 subjects who underwent gastroscopy by the eight endoscopists, 712 CSGLs were detected in 551 subjects. Fifty-six CSGLs (7.9%) in 55 subjects (10.0%) were not detected during the SSS. Photo-endoscopists who took more images achieved a higher detection rate of CSGLs than those who took fewer images (adjusted OR 2.07, 95% CI 1.41~3.05; <i>P</i><0.0001).Conclusions: The modified SSS, which included 22 SSS images, the fundus, and the saddle area, detected significantly more CSGLs. This modified SSS should be validated with further prospective studies.
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24
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Bernante P, Balsamo F, Rottoli M, Sciannamea A, Di Simone MP, Iannelli A, Poggioli G. Cascade Stomach as a Risk Factor for Incomplete Resection of the Gastric Fundus in Laparoscopic Sleeve Gastrectomy: a Point of Technique. Obes Surg 2020; 30:5139-5141. [PMID: 32440775 DOI: 10.1007/s11695-020-04718-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Bernante
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy. .,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy. .,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.
| | - Francesca Balsamo
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Rottoli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
| | - Andrea Sciannamea
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
| | - Massimo P Di Simone
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Côte d'Azur, Nice, France
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Via Massarenti 9, 40138, Bologna, Italy.,Centre for the Study and Research of Treatment for Morbid Obesity, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Via Massarenti 9, 40138, Bologna, Italy
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25
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Stavrou G, Grosomanidis V, Sarafidou A, Tsiropoulos G, Triaridis S, Kotzampassi K. Percutaneous endoscopic gastrostomy through a cervical esophageal fistula. An alternative, much improved technique for patient safety. Am J Otolaryngol 2020; 41:102408. [PMID: 32014301 DOI: 10.1016/j.amjoto.2020.102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Percutaneous endoscopic gastrostomy [PEG] by the pull-technique is easy and safe to perform through the oral cavity. However, the presence of a cervical esophageal fistula, either due to tumor invasion or simply inflammation and tissue necrosis after previous intervention or radiotherapy, in the anterior cervical region is of crucial importance when passing the endoscope and the PEG catheter from the mouth downwards. METHODS We describe a modification of the standard peroral PEG, which is to insert the endoscope from the cervical esophageal opening instead of the oral cavity, and we support the use of this "stoma" as a way to protect it and avoid possible forceful dilatation/expansion when advancing the endoscope and the gastrostomy catheter through the mouth. RESULTS The performance of PEG through the cervical esophageal opening was applied in 8 cases of esophageal fistula of different primary etiology but where the oro-pharyngeal passage was easily accessible. The procedure was technically successful in all patients, and no bleeding or tearing of the friable esophageal wall was evident. CONCLUSION The use of the esophageal fistula at the anterior cervical region as a route for PEG insertion is a safe and practical alternative, highly to be recommended.
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Affiliation(s)
- George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece; Department of Colorectal Surgery, Addenbrooke's Hospital, Hills Road, CB22QQ Cambridge, UK.
| | - Vassilios Grosomanidis
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece.
| | - Anastasia Sarafidou
- Department of Otorhinolaryngology-Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece.
| | - Gavriil Tsiropoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece.
| | - Stefanos Triaridis
- Department of Otorhinolaryngology-Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece.
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece; Endoscopy Unit, Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece.
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Opio CK, Rejani L, Kazibwe F, Ocama P. The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic. Afr Health Sci 2019; 19:3225-3234. [PMID: 32127900 PMCID: PMC7040339 DOI: 10.4314/ahs.v19i4.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Variceal upper gastrointestinal bleeding (UGIB) is common in sub-Saharan Africa (SSA). However, poor access to endoscopy services precludes the diagnosis of varices. OBJECTIVES We determined the diagnostic accuracy of routine clinical findings for detection of esophageal varices among patients with UGIB in rural SSA where schistosomiasis is endemic. METHODS We studied patients with a history of UGIB. The index tests included routine clinical findings and the reference test was diagnostic endoscopy. Multivariable regression with post-estimation provided measures of association and diagnostic accuracy. RESULTS We studied 107 participants with UGIB and 21% had active bleeding. One hundred and three (96%) had liver disease and 86(80%) varices. Factors associated with varices (p-value <0.05) were ≥ 4 lifetime episodes of UGIB, prior blood transfusion, splenomegaly, liver fibrosis, thrombocytopenia, platelet count spleen diameter ratio <909, and a dilated portal vein. Two models showed an overall diagnostic accuracy of > 90% in detection of varices with a number needed to misdiagnose of 13(number of patients who needed to be tested in order for one to be misdiagnosed by the test). CONCLUSION Where access to endoscopy is limited, routine clinical findings could improve the diagnosis of patients with UGIB in Africa. The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic.
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Affiliation(s)
- Christopher K Opio
- Makerere University, College of Health Sciences, P.O.Box 7072, Kampala, Uganda
| | - Lalitha Rejani
- Makerere University, College of Health Sciences, P.O.Box 7072, Kampala, Uganda
| | - Francis Kazibwe
- Bishop Stuart University, Public Health Department, P.O.Box 9, Mbarara, Uganda
| | - Ponsiano Ocama
- Makerere University, College of Health Sciences, P.O.Box 7072, Kampala, Uganda
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Image Based High-Level Control System Design for Steering and Controlling of an Active Capsule Endoscope. J INTELL ROBOT SYST 2018. [DOI: 10.1007/s10846-018-0956-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Matsui T, Okada T, Kawada K, Okuda M, Ogo T, Nakajima Y, Kume Y, Ryotokuji T, Hoshino A, Tokairin Y, Michi Y, Harada H, Nakajima Y, Kawano T. Detection of Second Primary Malignancies of the Esophagus and Hypophraynx in Oral Squamous Cell Carcinoma Patients. Laryngoscope Investig Otolaryngol 2018; 3:263-267. [PMID: 30186956 PMCID: PMC6119782 DOI: 10.1002/lio2.179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/06/2018] [Accepted: 05/25/2018] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the usefulness of modified esophagogastroduodenoscopy (EGD) for the detection of second primary malignancies of the esophagus or hypopharynx in patients with oral squamous cell carcinoma and determine the association between the oral lesion subsite and esophageal or hypopharyngeal lesion occurrence. Study Design Retrospective review. Methods In total, 166 patients with oral squamous cell carcinoma without any established symptoms of esophageal or hypopharyngeal squamous cell carcinoma underwent modified EGD based on the Valsalva maneuver and U-turn method, image-enhanced endoscopy, and chromoendoscopy using Lugol's iodine for diagnosis. All suspected lesions were biopsied to determine the clinical stages and duplication rates. Odds ratios for the occurrence of duplicate lesions according to the oral lesion subsite were determined. Results In total, 37 esophageal and 16 hypopharyngeal lesions were detected. According to the Union for International Cancer Control/American Joint Committee on Cancer classification (2009), 75.7% and 5.4% esophageal lesions were classified as stage IA and IB, respectively, and 50% and 18.8% hypopharyngeal lesions as stage II and stage I, respectively. Approximately 59.1% and 50% esophageal and hypopharyngeal lesions, respectively, were successfully treated by endoscopic resection. Oral lesions involving the floor of the mouth were more frequently accompanied by second primary malignancies of the esophagus or hypopharynx. Conclusions Modified EGD is an effective noninvasive technique for early diagnosis and treatment of second primary malignancies of the esophagus and hypopharynx in patients with oral squamous cell carcinoma. In particular, patients with floor of the mouth lesions need close monitoring for hypopharyngeal and esophageal lesions. Level of Evidence 3b.
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Affiliation(s)
- Toshihiro Matsui
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Takuya Okada
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Kenro Kawada
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Masahumi Okuda
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Taichi Ogo
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Yutaka Nakajima
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Yuichiro Kume
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Tairo Ryotokuji
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Akihiro Hoshino
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Yutaka Tokairin
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Yasuyuki Michi
- Department of Maxillofacial Surgery Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Tokyo Japan
| | - Hiroyuki Harada
- Department of Oral & Maxillofacial Surgery Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Tokyo Japan
| | - Yasuaki Nakajima
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
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Kim JS, Kim BW. Training in Endoscopy: Esophagogastroduodenoscopy. Clin Endosc 2017; 50:318-321. [PMID: 28783922 PMCID: PMC5565047 DOI: 10.5946/ce.2017.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal endoscopy is important in diagnosis, treatment, and prevention of many diseases of the digestive tract. The ability to perform esophagogastroduodenoscopy (EGD) safely, effectively, and efficiently has become the mainstay of gastroenterology practice. In Korea, EGD education is usually imparted as a component of gastroenterology training programs during fellowship. In this review, we discuss the general principles of EGD training. Formal curriculum development with devising clear goals and effective training methods should be developed in the future.
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Affiliation(s)
- Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
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Daileda T, Baek P, Sutter ME, Thakkar K. Disaccharidase activity in children undergoing esophagogastroduodenoscopy: A systematic review. World J Gastrointest Pharmacol Ther 2016; 7:283-293. [PMID: 27158545 PMCID: PMC4848252 DOI: 10.4292/wjgpt.v7.i2.283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/05/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the utility of intestinal disaccharide analysis during esophagogastroduodenoscopy (EGD) in children, we performed a systematic review of studies examining disaccharide activity.
METHODS: All full-length articles published in English during 1966-2014 were included if: (1) participants had small intestinal biopsy evaluation of disaccharide activity; (2) levels of lactase, sucrase, maltase or palatinase were reported; and (3) age of participants was under 18 years.
RESULTS: Thirty articles examining 34753 disaccharide assays fulfilled the specific search, inclusion, and exclusion criteria. All of the studies were observational in design and 57% (17) were prospective. Sixteen studies were conducted in the United States and 9 European studies were identified. The biggest study enrolled about 30, 314 procedures and 13 studies investigated fewer than 50 procedures. Eleven studies examined Caucasian subjects, 3 studies examined Asian subjects, and 6 examined African subjects. Only one Hispanic subject was included. In studies reporting disaccharide deficiency, the overall proportion of lactase deficiency was 39.2%, sucrase deficiency was 9.0%, maltase deficiency was 12.6% and palatinase deficiency was 9.1%. The prevalence of duodenal inflammatory changes ranged from 6% to 24% for non-specific histological lesions (e.g., duodenitis). Sixteen studies examined the association of histologic findings with disaccharide activities, and 12 studies reported an inverse association between degree of histologic inflammation and disaccharide levels.
CONCLUSION: We reviewed 30 studies including 34753 biopsy specimens with disaccharide analysis from children undergoing EGD. Our findings advocate a large study is to further illuminate the importance of EGD with disaccharide analysis in children.
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Nakano T, Sato C, Sakurai T, Kamei T, Nakagawa A, Ohuchi N. Use of water jet instruments in gastrointestinal endoscopy. World J Gastrointest Endosc 2016; 8:122-127. [PMID: 26862362 PMCID: PMC4734971 DOI: 10.4253/wjge.v8.i3.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/06/2015] [Accepted: 12/02/2015] [Indexed: 02/05/2023] Open
Abstract
In recent years, water jet instruments have been used in the field of gastrointestinal endoscopy, mainly in two clinical situations: Investigation and treatment under endoscopic view. Injecting water jet into the gastrointestinal lumen is helpful for maintaining a clear endoscopic view, washing away blood or mucous in the lumen or on the surface of the tip of the endoscope. This contributes to reducing time and discomfort of examination. Water jet technology is an alternative method for dissecting soft tissue; this method does not harm the small vessels or cause mechanical or thermal damage. However, its use in clinical settings has been limited to the transmucosal injection of water into the submucosal layer that elevates the mucosa to prepare for endoscopic mucosal resection or endoscopic submucosal dissection, instead of tissue dissection, which may occur because of the continuous water jet. A preclinical study has been conducted using a pulsed water jet system as an alternative method for submucosal dissection by reducing intraoperative water consumption and maintenance of dissection capability. This review introduces recent studies pertaining to using a water jet in gastrointestinal endoscopy and discusses future prospects.
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