Conventional Endoscopy Research Articles

Influence of different methods of silicone tube intubation on clinical effects and safety of patients with chronic dacryocystitis

Objective:To investigate the influence of conventional STI and endoscopic STI on clinical effects and safety of patients with chronic dacryocystitis. Method:One hundred and ten patients with chronic dacryocystitis were chosen in the period in our hospital and randomly divided into two groups including conventional group（55 patients） with conventional STI and endoscopy group（55 patients） with endoscopic STI. The improvement rate of epiphora symptoms, ocular surface symptoms score before and after treatment, operation time, intraoperative VAS score and postoperative complication rate of both groups were compared. Result:There was no significant difference in the improvement rate of epiphora symptoms between two groups（P>0.05）. The ocular surface symptoms score after treatment of endoscopy group were significantly less than conventional group（P<0.05）. There was no significant difference in the ocular surface symptoms score after treatment between two groups（P>0.05）. The operation time and intraoperative VAS score of endoscopy group were significantly less than conventional group（P<0.05）. The postoperative complication rate of endoscopy group were significantly lower than conventional group（P<0.05）. Conclusion:Conventional STI and endoscopic STI in the treatment of patients with chronic dacryocystitis possess the same clinical effects; but endoscopic STI application can efficiently reduce operation difficulty, relieve intraoperative pain and prevent postoperative complications.

A Novel Flexible Robotic Endoscope With Constrained Tendon-Driven Continuum Mechanism

This letter presents a novel flexible robotic endoscope with a constrained tendon-driven continuum mechanism (CTCM) which is targeted for bariatric surgery. The robotic endoscope is composed of a UR5 robot and a CTCM-based flexible endoscope. By introducing a constraint tube, both the angulation and the length of the flexible segment can be controlled, ensuring improved flexibility and dexterity. The kinematic modeling of the flexible robotic endoscope is conducted with the remote center of motion (RCM) constraints and physical limits of the robotic system considered. To automate the endoscope robot, image-based visual servoing technique is employed. The kinematics modeling results in a quadratic programming (QP) based control framework with the physical limits and RCM constraints of the robotic endoscope involved. Experimental validation is performed to verify the effectiveness and superiority of the CTCM-based flexible endoscope for bariatric surgery as compared with conventional rigid and flexible endoscopes.

Non-small-bowel lesions identification by capsule endoscopy: A single centre retrospective study

Capsule endoscopy has been considered the first-line approach for the investigation of obscure gastro-intestinal bleeding since its approval in 2001. Our study aims to evaluate the diagnostic yield of capsule endoscopy in the investigation of this condition. We also analyse the incidence of non-small-bowel lesions missed after conventional endoscopy and later detected by capsule endoscopy in patients with suspected obscure bleeding. A total of 290 patients with negative conventional endoscopy referred to our centre to undergo a capsule endoscopy examination for the investigation of obscure gastro-intestinal bleeding. We considered as non-small-bowel lesions those outside the tract between the second duodenal portion and the ileocecal valve. We also looked for actively bleeding lesions at the time of the exam. Intestinal preparation was good, adequate or poor in 74.1%, 8.4%, and 17.5% of the tests, respectively. Caecum was reached in 92.4%. Capsule retention occurred in 0.7%. Mean small bowel transit time was 5hours and 13minutes. Diagnostic yield was 73.8%. An actively bleeding lesion was noticed in 39.3% of positive tests. Capsule endoscopy revealed clinically significant non-small-bowel lesions missed at gastroscopy or colonoscopy in 30.3% of patients, 43.2% of which were bleeding. Capsule endoscopy has high diagnostic yield and safety in the investigation of obscure gastro-intestinal bleedings. Given the high percentage of non-small-bowel lesions detected, it may be appropriate to consider an endoscopic second look before performing a capsule endoscopy study.

Diagnosis of invasion depth in resectable advanced gastric cancer for neoadjuvant chemotherapy: An exploratory analysis of Japan clinical oncology group study: JCOG1302A

BackgroundNeoadjuvant chemotherapy (NAC) is increasingly used for resectable locally advanced gastric cancer (LAGC). JCOG1302A investigated the diagnostic criteria of LAGC patients with cT3–4/N1–3 to minimize contamination of pathological stage I as a candidate for NAC. In JCOG1302A, 77.2% of cT3–4 tumors diagnosed via a combination of endoscopy and computed tomography (CT) were pT3–4. However, the role of endoscopic ultrasonography (EUS) and additional diagnostic procedures/modalities remains unclear. Here, we investigated whether EUS, thin-slice CT, and foaming agent (FA) in CT contribute to accurate diagnosis of AGC invasion depth. MethodsUsing JCOG1302A study data, we compared positive predictive value (PPV), negative predictive value (NPV), and kappa index (KI) between conventional and additional diagnostic procedures to identify pT3–4: conventional endoscopy (CE) with versus without EUS, 1-mm versus 5-mm CT slice, and CT with versus without FA. ResultsWe analyzed 1232 patients’ data. PPV, NPV, and KI were 79.2%/73.7%, 59.2%/58.8%, and 0.38/0.39 (CE alone/CE with EUS), 77.8%/75.5%, 62.9%/71.2%, and 0.38/0.39 (5-mm CT/1-mm CT), and 78.6%/75.1%, 60.9%/69.7%, and 0.38/0.40 (CT without FA/CT with FA), respectively. Overall, there were no remarkable differences in any comparison. More specifically, PPV and KI were slightly higher with CE alone rather than CE with EUS. Although NPV was higher for 1-mm CT and CT with FA, PPV was rather higher for 5-mm CT and CT without FA. ConclusionAdditional diagnostic procedures/modalities, like EUS, 1-mm slice CT, or FA in CT may not improve the diagnostic accuracy of invasion depth in resectable LAGC.

Quantitative Diagnosis of Atrophic Gastritis by Probe-Based Confocal Laser Endomicroscopy.

Aims The aims of this study were to characterize nonatrophic and atrophic gastric mucosa under conventional endoscopy and probe-based confocal laser endomicroscopy (pCLE) modes and to define quantitative diagnostic parameters for these lesions under pCLE. Method In phase I, 64 patients with gastric mucosal lesions diagnosed by gastrointestinal endoscopy were enrolled in the study. Normal mucosa and suspicious lesions were evaluated under normal white light imaging (WLI) and pCLE mode. Descriptive characteristic of gastric mucosal inflammation and atrophy under pCLE were defined according to the histology. In phase II, the criteria for nonatrophic gastritis (NAG) and chronic atrophic gastritis (CAG) under pCLE were used to diagnose the mucosal lesions in 431 patients. Diagnostic accuracy of each endoscopy modes was evaluated by measuring the concordance with histology. Result A total of 64 patients with 187 positions were enrolled in the first part of this study. According to the histological diagnosis, the vessel diameter was increased in the NAG (11.18 ± 0.1 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 Conclusion pCLE shows high potential for the diagnosis of gastric inflammation and atrophy based on quantitative criteria and has the ability to be a substitute for histology in the diagnosis of diffuse lesions in the stomach.

Correction: ERCP using a conventional upper gastrointestinal endoscope for a patient with a type I duodenal stricture.

Correction: ERCP using a conventional upper gastrointestinal endoscope for a patient with a type I duodenal stricture.

Theranostic Gastrointestinal Endoscopy: Bringing Healing Light to the Lumen.

Current conventional endoscopes have restricted the accuracy of treatment delivery and monitoring. Over the past decade, there have been major developments in nanotechnology and light triggered therapy, potentially allowing a better detection of challenging lesions and targeted treatment of malignancies in the gastrointestinal tract. Theranostics is a developing form of personalized medicine because it combines diagnosis and targeted treatment delivered in one step using advances in nanotechnology. This review describes the light-triggered therapies (including photodynamic, photothermal, and photoimmunotherapies), nanotechnological advances with nanopowder, nanostent, nanogels, and nanoparticles, enhancements brought to endoscopic ultrasound, in addition to experimental endoscopic techniques, combining both enhanced diagnoses and therapies, including a developed prototype of a “smart” multifunctional endoscope for localized colorectal cancer, near-infrared laser endoscope targeting the gastrointestinal stromal tumors, the concept of endocapsule for obscure gastrointestinal bleed, and a proof-of-concept therapeutic capsule using ultrasound-mediated targeted drug delivery. Hence, the following term has been proposed encompassing these technologies: “Theranostic gastrointestinal endoscopy.” Future efforts for integration of these technologies into clinical practice would be directed toward translational and clinical trials translating into a more personalized and interdisciplinary diagnosis and treatment, shorter procedural time, higher precision, higher cost-effectiveness, and less need for repetitive procedures.

Development and clinical application of magnetic navigation technology

As the industrialization level has been continuously developed since the 21st century, the magnetic navigation system has been under constant human transformation. At the same time, due to the cross integration of computer-aided technology (CAT), imaging technology and other disciplines, the magnetic navigation technology has been applied in a wider range. As a result, the technology has been proven to have huge advantages currently in the navigation of heart and cerebral vessels, the digestive tract, and the respiratory tract. Here is more detailed information on the magnetic navigation technology: The magnetic navigation system for surgery serves as the operating platform of the technology, and the result of optimized and integrated multidisciplinary technologies. Let’s trace back to the inception of concept of the magnetic navigation system: The concept of the magnetic navigation system was first put forward in 1984. From then on, the magnetic navigation system has gone through four generations. In this update period, the system has realized more comprehensive functions. As a result, compared with the traditional operation, the magnetic navigation technology serves as a more effective solution to steric hindrance in operations that conventional interventions fail to deliver. The advantages of this technology lie in small injuries, easy operation and remarkable treatment effect. Apart from the aforementioned content, according to the multicenter clinical application research in recent years, the magnetic navigation system has been proven to have the following advantages: First of all, vascular interventions in the context of magnetic navigation are more likely to lead to successful results and show more advantages in dealing with complicated pathological changes; what’s more, magnetically-controlled capsule endoscopy (MCE) significantly reduces testing time, and it has also been further applied to test indications; and last but not least, magnetic navigation bronchoscope leads to better diagnosis rates and plays an important role in the positioning of peripheral pulmonary pathological changes and the relevant drug delivery. In spite of the aforementioned huge advantages, the magnetic navigation technology is still limited in many aspects. For instance, first of all, the application of the magnetic navigation technology can cause some indications that may have bad effects on metal implants; apart from this, the typical gradient magnetic field makes the magnetic navigation system unable to have more accurate control over the response unit, and MCE is yet to be applied to treatment as conventional endoscopes due to the dead zones in its observation. Due to the aforementioned reasons, the research on the technology at present is focused on the control mode, design of the response unit, and wider applications. To give more specific examples here: In recent years, the closed-loop control mode and the implantation of the needle-like structure of capsule endoscopy, and other new technologies have been developed, aiming to realize more accurate control over the response unit and more endoscopic operations. Based on the above content, the present paper provides a literature review of the clinical applications of the magnetic navigation technology based on its previous development history.

Value of magnetic resonance enterography in diagnosis and treatment follow up in Crohn’s disease in children

PurposeCrohn’s disease (CD) is a chronic inflammatory disease which can affect all parts of the gastrointestinal tract. Magnetic resonance enterography (MRE) enables detection of pathologic changes in the small intestine, which are not accessible by conventional endoscopy. The aim of the study was to assess the value of MRE in imaging of small bowel lesions, their location and extent, in CD patients and its correlation with clinical and endoscopic activity. Materials and methodsMRE was performed in 108 children with CD, aged 5.5 to 18 years. The diagnosis was based on the Porto criteria. Location and clinical manifestation was evaluated according to the Paris classification. Clinical CD activity was assessed with PCDAI and endoscopic activity with SES-CD. In 36 children, control MRE was performed. ResultsThe most common endoscopic location of the disease was the colon (41.7%), terminal ileum and colon (24.1%). Inflammation as the main clinical manifestation was dominant (81.5%). In MRE, inflammatory changes were found in 40.8% of children, strictures in 11.1%. The EIA value (activity in MRE) increased along with PCDAI score and SES-CD. MRE performed during follow up, showed transmural healing in 16.7% of patients and improvement in 55.5%. ConclusionsMRE is an efficient diagnostic tool in proper characterization of disease location in pediatric CD. As positive correlation of the results of MRE with the endoscopic and clinical activity has been found, taking into account good tolerance and non-invasiveness of the procedure it can be recommended to be used in reassessment.

Detection of early adenocarcinoma of the esophagogastric junction by spraying an enzyme-activatable fluorescent probe targeting Dipeptidyl peptidase-IV

BackgroundIt is still difficult to detect and diagnose early adenocarcinoma of the esophagogastric junction (EGJ) using conventional endoscopy or image-enhanced endoscopy. A glutamylprolyl hydroxymethyl rhodamine green (EP-HMRG) fluorescent probe that can be enzymatically activated to become fluorescent after the cleavage of a dipeptidyl peptidase (DPP)-IV-specific sequence has been developed and is reported to be useful for the detection of squamous cell carcinoma of the head and neck, and esophagus; however, there is a lack of studies that focuses on detecting EGJ adenocarcinoma by fluorescence molecular imaging. Therefore, we investigated the visualization of early EGJ adenocarcinoma by applying EP-HMRG and using clinical samples resected by endoscopic submucosal dissection (ESD).MethodsFluorescence imaging with EP-HMRG was performed in 21 clinical samples resected by ESD, and the fluorescence intensity of the tumor and non-tumor regions of interest was prospectively measured. Immunohistochemistry was also performed to determine the expression of DPP-IV.ResultsFluorescence imaging of the clinical samples showed that the tumor lesions were visualized within a few minutes after the application of EP-HMRG, with a sensitivity, specificity, and accuracy of 85.7, 85.7, and 85.7%, respectively. However, tumors with a background of intestinal metaplasia did not have a sufficient contrast-to-background ratio since complete intestinal metaplasia also expresses DPP-IV. Immunohistochemistry measurements revealed that all fluorescent tumor lesions expressed DPP-IV.ConclusionsFluorescence imaging with EP-HMRG could be useful for the detection of early EGJ adenocarcinoma lesions that do not have a background of intestinal metaplasia.

Second-generation magnetically controlled capsule gastroscopy with improved image resolution and frame rate: a randomized controlled clinical trial (with video)

Compared with conventional endoscopy, magnetically controlled capsule gastroscopy (MCCG) can be further optimized in gastric examination time and complete visualization of upper GI (UGI) mucosa. The second-generation MCCG (MCCG-2) was developed with higher image resolution and adaptive frame rate, and we aimed to evaluate its clinical availability for UGI examination in this study. Consecutive patients undergoing MCCG examination between May to June 2019 were prospectively enrolled and randomized to swallow the first-generation MCCG (MCCG-1) or MCCG-2 in a 1:1 ratio. The main outcomes included visualization of the esophagus and duodenum, operation-related parameters, image quality, maneuverability, detection of lesions, and safety evaluation. Eighty patients were enrolled. In the MCCG-2 group, frames captured for esophageal mucosa and Z-line were 171.00 and 2.00, significantly increased from those in the MCCG-1 group (97.00 [P= .002] and .00 [P= .028], respectively). The gastric examination time was shortened from 7.78 ± .97 minutes to 5.27 ± .74 minutes (P< .001), with the total running time of the capsule extended from 702.83 minutes to 1001.99 minutes (P< .001). MCCG-2 also greatly improved the image quality (P< .001) and maneuverability (P< .01). No statistical difference existed in the detection of lesions between the 2 groups, and no adverse events occurred. MCCG-2 showed better performance in mucosal visualization, examination duration, and maneuverability, making better diagnosis of UGI diseases a possibility. (Clinical trial registration number: NCT03977935.).

A model of predicting infiltration depth of early gastric cancers based on conventional white light endoscopy and magnifying endoscopy with narrow band imaging findings

Objective To analyze the characteristics of early gastric cancer (EGC) with submucosal infiltration under conventional white light endoscopy (C-WLE) and magnifying endoscopy with narrow band imaging (ME-NBI), and to improve the diagnostic accuracy of EGC infiltration by combining C-WLE and ME-NBI findings. Methods Data of patients who received endoscopic submucosal dissection or surgical treatment for EGC at Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively analyzed. The basic information, lesion characteristics, and postoperative pathology of patients were collected. The characteristics of EGC with submucosal infiltration were analyzed, and a model for predicting the depth of EGC invasion was constructed by combining independent risk factors of submucosal infiltration. Results A total of 207 lesions in 195 patients were included in the study, divided into the modeling group (138 lesions) and the testing group (69 lesions) in the ratio 2∶1. In the modeling group, the lesions located in the upper third of the stomach (OR=12.949, 95%CI: 2.148-78.070, P=0.005), middle third of the stomach (OR=7.534, 95%CI: 1.044-54.360, P=0.045), >2 cm in size (OR=6.828, 95%CI: 1.657-28.136, P=0.008) and presence of dilated blood vessel (OR=6.856, 95%CI: 1.577-29.805, P=0.010) were independent risk factors for submucosal infiltration. Based on the above independent risk factors, the infiltration depth predicting scoring system (DPSS) was constructed (5 points for the lesion located in upper third of the stomach, 4 points for the lesions located in the middle third of stomach, 4 points for lesions >2 cm in size, and 4 points for the presence of dilated vessels). The areas under the receiver operating characteristic curve for predicting the infiltration depth of DPSS were 0.884 (95%CI: 0.809-0.960) in the modeling group and 0.799 (95%CI: 0.684-0.914) in the testing group. The sensitivities of the modeling group and the testing group were 83.3% and 71.4% respectively; and the specificities were 76.2% and 74.5%, respectively in the two groups at 8 as the cut-off score. Conclusion The DPSS based on C-WLE and ME-NBI findings can predict the invasion depth of EGC. Key words: Stomach neoplasms; Early diagnosis; Tumor infiltrating; Forecasting models; Magnification endoscopy with narrow band imaging

Assessment of gastric acidity by short-duration intragastric pH-monitoring with standardised breakfast in functional and some other dyspepsias

IntroductionPreliminary assessment of gastric secretion in the treatment of organic and functional dyspepsia may offer advantages over the empirical administration of proton pump inhibitors suggested by most clinical guidelines.AimTo develop a simplified pH-metric test with standardised meal, and on its basis to perform an assessment of the functional state of gastric secretion in the most common dyspepsias.Material and methodsSerum pepsinogen 1 and 2 were used for reference. Intragastric pH-monitoring was performed during 45 min in basal phase and 135 min after provocative breakfast (507 kcal, 100 mg caffeine). Consecutive adults enrolled in the study were divided into groups: 1 – “Non-dyspeptic” – 30 persons; 2 – “Duodenal peptic ulcer” – 13; 3 – “GERD” – 82; and 4 – “Functional dyspepsia” – 125 patients.ResultsThere was a moderate association between concentration of pepsinogen-1 and parameters of pH-monitoring. The best correlation coefficients were for the nadir pH in basal conditions and the time of acid neutralisation > 3.5 after the meal – r = –0.534 and r = –0.541, respectively (p < 0.0001). Using these two parameters we considered discriminants for four patterns of acidity. Proposed criteria of Hipo-anacidity included an absence of active secretion of hydrochloric acid in basal (pHmin > 5) and postprandial phases, with the achievement of stable pH < 3.5 after 80 min from meal time. They showed sensitivity 88.9% and specificity 100%. In cases of a detected pattern of hyperacidity, these parameters were 80% and 66.67%, respectively. According to the prevalence of hyperacidic cases, the groups were ranked in the following order: duodenal ulcer (76.9%) – GERD (51.1%) – functional dyspepsia (40.8%) – non-dyspeptic (19.0%).ConclusionsAcid production is increased among patients with functional dyspepsia. There is a small number of patients with functional dyspepsia (12.1%) with hypochlorhydria due to atrophic gastritis. The latter was independently associated with age > 50 years (OR = 20.139), symptoms of postprandial distress-syndrome (OR = 9.821), and signs of atrophy (OR = 5.914) after conventional endoscopy.

Pan-enteric capsule for bleeding high-risk patients. Can we limit endoscopies?

obscure gastrointestinal bleeding is defined as bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy and capsule endoscopy is the next step in these patients. Some patients may be unsuitable for conventional endoscopy and performing a capsule panendoscopic test as a first line procedure might potentially reduce the number of endoscopies and their subsequent risk. to analyze our experience with capsule endoscopy in the bleeding setting. the first 100 panendoscopic capsule procedures performed in our center from August 2011 until December 2016 were retrospectively reviewed. positive findings were observed in 61.2 % of patients; 46.26 % had a previous negative gastroscopy and the capsule detected small bowel lesions in 67.7 % and colonic findings in 80.64 %. Taking into consideration that our population were high-risk patients (mainly because of comorbidities) and that we used up to 45 ml of sodium phosphate, sodium, potassium and creatinine changes were analyzed before and after procedure. The mean "before" values were 140.68, 4.04 and 1.36, respectively. The mean "after" values were 140.28, 3.9 and 1.35 (p = n.s.). According to our findings, no other endoscopic studies would be needed in 64.5 % of patients with negative gastroscopy. According to capsule results, conventional endoscopy could have been avoided in 68.6 % of cases. panendoscopy with a capsule may be useful and safe in bleeding high-risk patients, by selecting those who need therapeutic endoscopy, avoiding up to 68.6 % of diagnostic endoscopies in our series.

The Comparison of Diagnostic Significance of Narrow Band Imaging in Contrast of White Light Endoscopy in the Assessment of Nasopharyngeal Cancer

Background: Narrow band imaging (NBI) is reported to improve the diagnostic importance of nasopharyngeal cancer. The purpose of this review was to evaluate the diagnostic significance of NBI in the literature and compare it to the conventional white light endoscopy. The use of narrow band imaging (NBI) and further technological achievements concerning the resolution and magnification of endoscopic images have in the past 15 years. With the use of NBI, superficial mucosal lesions, which may be missed by standard WLI endoscopy, can be identified easily by their neoangiogenic pattern. Objective: To assess diagnostic value of the narrow band imaging and white light endoscopy in nasopharyngeal carcinoma and compare diagnostic values (sensitivity, specificity, positive predictive value and negative predictive value) with white light endoscopy. Search Methods: From 2010 to 2020, data was searched from electronic databases such as PubMed, web of science. We used narrow band imaging as a key word accordance with diagnostic modalities such as sensitivity, specificity, PPV and NPV and data were collected. Results: We have found mainly 6 studies have discussed about diagnostic value of endoscopy in nasopharyngeal carcinoma in the total of 2746 suspected patients. Among them, 5 studies have compared diagnostic values such as sensitivity, specificity, positive predictive value and negative predictive value between NBI and WLE. Among 5 studies, 4 studies have found higher sensitivity in NBI, 2 studies found higher 1 equal to WLE specificity in NBI. 3 studies have compared PPV and NPV between NBI and WLE. Among them, all the studies found higher PPV and NPV in NBI than WLE. Conclusion: Recently developed narrow band imaging has a great significance in the diagnosis of nasopharyngeal carcinoma. Although NBI has also encountered some problem such as contact bleeding and darker image. So, further evaluation should be done.

Diagnosis and Surgical Extraction of Large Gastric Trichobezoars: A Single Center Study of Two Cases

Trichobezoars are compact mass of hair occupying the gastric cavity that if left untreated can cause developmental delay, malnutrition, obstruction or perforation. The treatment options include extraction by conventional laparotomy, laparoscopy, gastrotomy or endoscopy. Since they are almost always associated with trichotillomania and trichophagia or other psychiatric disorders, psychiatric consultation is necessary to prevent relapses. We reviewed the medical charts of two patients with trichobezoar who were treated at Lord Mahavir, Civil Hospital, Ludhiana. Both the cases, aged 14 and 19 years were females and presented at the hospital with a history of epigastric discomfort, pain and vomiting. Both the girls were lean, underweight and pale skinned. First patient had trichotillomania and trichophagia for 1 year prior to presentation. The parents were unaware of patient’s trichophagia but the girl revealed that she ate hair during the night. The second patient had no history of trichophagia and the bilateral loss of scalp hair indicated nocturnal involuntary eating of hair during sleep. The large palpable mass in both the cases was non-tender, hard, smooth and mobile on examination. The abdominal imaging with CT revealed the mass occupying most of the gastric cavity, and turned out to be trichobezoars. The masses were successfully extracted by laparotomy and gastrotomy. A trichobezoar represents a serious surgical condition. It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present. Gastrotomy was found to be very successful for the surgical removal of trichobezoars. The behavioral assessment and psychiatric counselling also plays a useful role in patient management and prevention of recurrence.

Surgical Robot for Intraluminal Access: An Ex Vivo Feasibility Study.

Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection (ESD) using a flexible endoscope. Compared with conventional percutaneous surgery, ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision, and the organ is preserved. However, the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices, which have limited degrees of freedom. To facilitate easier manipulation of these flexible devices, we developed a surgical robot comprising a flexible endoscope and two articulating instruments. The robotic system is based on a conventional flexible endoscope, and an extrapolated motor unit moves the endoscope in all its degrees of freedom. The instruments are thin enough to allow insertion of two instruments into the endoscope channel, and each instrument has a bending section that allows for up-down, right-left, and forward-backward motion. In this study, we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach. The procedure was successfully performed by five novice operators without complications. Our findings demonstrated the feasibility of the proposed robotic system and, furthermore, suggest that even operators with limited experience can use this system to perform ESD.

Protocolo de indicaciones de la videocápsula endoscópica

Since its introduction in 2000, video capsule endoscopy (VCE) has become a first-line device for the study of the small bowel (SB), revolutionizing diagnostic approach and SB diseases management. It is a minimally invasive technique that visualizes the mucosal surface hitherto inaccessible to conventional endoscopy. It is indicated for digestive bleeding of obscure origin, Crohn's disease suspicion, celiac disease, small bowel tumors and small-bowel surveillance of patients with hereditary polyposis syndromes. It may be useful in the study of other areas of the gastrointestinal tract. Despite being a minimally invasive and safe technique, it is not without complications, such as retention in SB and contraindications.

Role of Endoscopic Ultrasound-Fine Needle Aspiration in Management of Submucosal Lesions (SMLs) of GIT and Significant Predictors of Malignancy of GIST Lesions

Background: Submucosal lesion is a mass or bulge covered by normal-appearing mucosa identified during standard endoscopy. Endoscopic Ultrasound (EUS) allows precise differentiation of the individual layers of the gastrointestinal (GI) tract. Endoscopic Ultrasound-Fine Needle Aspiration (EUS-FNA) permits safe and accurate sampling of submucosal lesions (SMLs) for further histopathology. Gastrointestinal stromal tumors are the commonest mesenchymal neoplasms of the GI tract. They should be stratified by malignant potential according to tumor size, location, and mitotic count. Objectives: The aim of work was to evaluate the role of endoscopic ultrasound with EUS-FNA in management of submucosal gastrointestinal lesions, with special concern about gastrointestinal stromal tumors (GISTs) lesions and the criteria highly associated with malignant nature. Patients and methods: This multi-center prospective study included a total of 150 patients with gastrointestinal submucosal lesions, conducted to evaluate EUS and EUS-FNA as diagnostic tools of submucosal lesions, including 68 GIST lesions. All patients underwent conventional endoscopy, EUS-FNA and histopathological examination of the samples obtained in Theodor Bilharz Research Institute, Cairo University Hospital and Kobry El Qubba Military Hospital from 2015 to 2017. Results: There were 150 patients with submucosal GI lesions, including 93(62%) males and 57(38%) females, with the mean age of 52±11.9 years. Presentations included dyspepsia 73(48.7%), asymptomatic SMLs 31(20.7%). The lesions were mainly gastric 102(68%). Final diagnoses were GIST 68 (45.3%), lipoma 11(7.3%), leiomyoma 9(6%) and extramural lesions 7(4.7%). There were 68 patients with GIST lesions, including 43(63.2%) males and 25(36.8%) females, with the mean age of 54±10.3 years. Presentations included dyspepsia 41(63.2%), asymptomatic SMLs 16(23.5%). The lesions were mainly gastric 57(83.8%). Sensitivity and specificity were 88.6% and 100% of EUS-FNA as diagnostic tools for GIST lesions respectively. (PPV) and (NPV) were 100% and 82.8% respectively. Conclusion: It could be concluded that EUS and EUS-FNA were highly significant methods in diagnosis of GIST lesions in relation to final histopathology.

The role of a transparent cap in the endoscopic removal of foreign bodies in the esophagus: A propensity score-matched analysis.

ObjectiveTo investigate the effectiveness and safety of transparent cap‐assisted endoscopy in removing foreign bodies in the esophagus.MethodsPatients with foreign body lodged in the esophagus who received a transparent cap‐assisted or conventional endoscopy between October 2004 and July 2018 were retrospectively enrolled. Propensity score matching was performed. The success rate of the endoscopic procedure, procedure time, clearness of endoscopic view and adverse event rate were compared between the two groups.ResultsOf the 838 patients who had a foreign body lodged in the esophagus, 728 (86.9%) underwent endoscopic intervention. After matched by prospensity score, 224 patients each received either transparent cap‐assisted endoscopy or conventional endoscopy. No difference was noted between the two groups in terms of the success rate (100% vs 99.1%, P = 0.499). Transparent cap‐assisted endoscopy was associated with shorter procedure time for removing jujube pits ([4.24 ± 2.81] min vs [7.62 ± 8.15] min, P = 0.001), fish bones ([2.99 ± 2.15] min vs [6.49 ± 6.54] min, P < 0.001) and other sharp objects ([4.29 ± 3.36] min vs [10.60 ± 19.79 min], P = 0.027) and higher rates of clear endoscopic views in extracting jujube pits, fish bones, poultry bones and other sharp objects (98% vs 43.4%, 97.5% vs 74.1%, 100% vs 81.3% and 100% vs 82.7%; all P < 0.05). No significant differences in the rates of adverse event were observed between the groups (P = 1.000).ConclusionTransparent cap‐assisted endoscopic technique is effective and safe for removing sharp foreign bodies in the esophagus.