Conventional Esophagogastroduodenoscopy Research Articles

Efficacy and Safety of Exploring Deeper Sections of the Infrapapillary Area of the Duodenum by Using Sedative Esophagogastroduodenoscopy.

Background Using conventional esophagogastroduodenoscopy (EGD) to evaluate the infrapapillary area is not feasible. The use of sedative EGD may enable endoscopists to investigate the infrapapillary condition of the duodenum. In this study, we aimed to evaluate lesions in the infrapapillary regions by using sedative EGD. Methods In this retrospective observational study, we used the data of patients who underwent sedative EGD examinations at a tertiary hospital in southern Taiwan. The endoscopists evaluated the esophagus, stomach, and proximal duodenum and then attempted to explore the infrapapillary portion of the duodenum as deeply as possible. We assessed the success rate for the exploration of infrapapillary areas. Furthermore, we analyzed specific clinical findings of sedative EGD examination. Results In total, 2973 patients underwent sedative EGD between November 1, 2010, and December 31, 2011. For 2632 of these patients, it was their first sedative EGD examination. In 2511 patients (95.4%), the exploration of the infrapapillary areas was successful. In approximately 10% of the patients, specific findings were detected over the infrapapillary region, and 7 of these patients exhibited clinically significant findings (i.e., gallbladder cancer with metastasis, periampullary Vater adenoma, natural killer cell enteropathy, villous adenoma with moderate dysplasia, infrapapillary duodenal adenoma with dysplasia, duodenal perforation with tumor-like formation, and follicular lymphoma). No patient experienced minor or major adverse reactions during the sedative EGD procedure. Conclusions The current study provided evidence that sedative EGD examination enables a safe, comfortable, and effective endoscopic examination of deeper sections of the duodenum to evaluate the papillary and infrapapillary regions.

Present status and the future of ultrathin endoscopy.

Endoscopic population-based screening for gastric cancer began in April 2016, and the use of transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) has rapidly become popular. With UT-EGD, discomfort associated with an examination is reduced, patient satisfaction is high, and adverse effects on cardiopulmonary function are fewer. Consequently, UT-EGD is a good option for gastric screening in an aging society. Because of the narrower diameter of the endoscope, however, image quality is inferior to that obtained using transoral conventional esophagogastroduodenoscopy (C-EGD). As a result, lesions observed by UT-EGD must be viewed at close proximity and chromoendoscopy should be used concurrently, which is burdensome for the endoscopist. Recent innovations by endoscope manufacturers have enabled dramatic improvements in transnasal UT-EGD and facilitated Hi-Vision imaging. Furthermore, image enhancement that allows for observation on a par with transoral C-EGD is now feasible. In the future, UT-EGD will be equipped with functions that permit magnified endoscopic image. It is anticipated that a multiroute transition between transnasal and transoral UT-EGD will become possible.

Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy.

Diagnostic unsedated transnasal endoscopy (uTNE) has been proven to be a safe and well-tolerated procedure. Although its utilization in the United Kingdom (UK) is increasing, it is currently available in only a few centers. Through consideration of recent studies, we aimed to perform an updated review of the technological advances in uTNE, consider their impact on diagnostic accuracy, and to determine the role of uTNE in the COVID-19 era. Current literature has shown that the diagnostic accuracy of uTNE for identification of esophageal pathology is equivalent to conventional esophagogastroduodenoscopy (cEGD). Concerns regarding suction and biopsy size have been addressed by the introduction of TNE scopes with working channels of 2.4 mm. Advances in imaging have improved detection of early gastric cancers. The procedure is associated with less cardiac stress and reduced aerosol production; when combined with no need for sedation and improved rates of patient turnover, uTNE is an efficient and safe alternative to cEGD in the COVID-19 era. We conclude that advances in technology have improved the diagnostic accuracy of uTNE to the point where it could be considered the first line diagnostic endoscopic investigation in the majority of patients. It could also play a central role in the recovery of diagnostic endoscopic services during the COVID-19 pandemic.

The Application of Magnetic-Controlled Capsule Gastroscopy in Patients Refusing C-EGD: A Single-Center 5-Year Observational Study.

Background and Aims Screening for gastric diseases in symptomatic outpatients with conventional esophagogastroduodenoscopy (C-EGD) is expensive and has poor compliance. We aimed to explore the efficiency and safety of magnetic-controlled capsule gastroscopy (MCCG) in symptomatic outpatients who refused C-EGD. Methods We performed a retrospective study of 76794 consecutive symptomatic outpatients from January 2014 to October 2019. A total of 2318 adults (F/M = 1064/1254) in the MCCG group who refused C-EGD were matched with adults in the C-EGD group using propensity-score matching (PSM). The detection rates of abnormalities were analyzed to explore the application of MCCG in symptomatic patients. Results Our study demonstrated a prevalence of gastric ulcers (GUs) in patients with functional dyspepsia- (FD-) like symptoms of 8.14%. The detection rate of esophagitis and Barrett's esophagus was higher in patients with typical gastroesophageal reflux disease (GERD) symptoms than in patients in the other four groups (P < 0.01). The detection rates of gastric ulcers in the five groups (abdominal pain, bloating, heartburn, follow-up, and bleeding) were significantly different (P = 0.015). The total detection rate of gastric ulcers in symptomatic patients was 9.7%. A total of 7 advanced carcinomas were detected by MCCG and confirmed by endoscopic or surgical biopsy. The advanced gastric cancer detection rate was not significantly different between the MCCG group and the C-EGD matched group in terms of nonhematemesis GI bleeding (2 vs. 2, P = 1.00). In addition, the overall focal lesion detection rate in the MCCG group was superior to that in the C-EGD matched group (224 vs. 184, P = 0.038). MCCG gained a clinically meaningful small bowel diagnostic yield of 54.8% (17/31) out of 31 cases of suspected small bowel bleeding. No patient reported capsule retention at the two-week follow-up. Conclusion MCCG is well tolerated, safe, and technically feasible and has a considerable diagnostic yield. The overall gastric diagnostic yield of gastric focal lesions with MCCG was comparable to that with C-EGD. MCCG offered a supplementary diagnosis in patients who had a previously undiagnostic C-EGD, indicating that MCCG could play an important role in the routine monitoring and follow-up of outpatient. MCCG shows its safety and efficiency in symptomatic outpatient applications.

Introduction of Transnasal Endoscopy to a Scottish District General Hospital.

Esophagogastroduodenoscopy can be uncomfortable and distressing with many patients opting for conscious sedation over topical local anesthetic spray. Transnasal endoscopy is an alternative and we sought to assess how easily it could be introduced to a district general hospital and how acceptable patients found it. Selected patients requiring diagnostic endoscopy were offered transnasal endoscopy with topical nasal anesthetic by clinicians new to transnasal endoscopy but competent at esophagogastroduodenoscopy. Postal feedback questionnaires were used to assess comfort, distress, recollection of periprocedural consultation, and overall experience (visual analog scale 1-10). A total of 213 transnasal endoscopy procedures were undertaken with 207 completed successfully (97.2%). Two patients (0.9%) had self-limiting epistaxis and no patient required admission. One hundred (47%) questionnaires were returned including 98 from those with completed transnasal endoscopy. Thirty-three (33%) had previous esophagogastroduodenoscopy and 28 (85%) reported a preference for transnasal endoscopy. Fifty-eight patients (59%) found transnasal endoscopy comfortable (visual analog scale >6) with 17 reporting discomfort (visual analog scale <5). Seventeen patients found the procedure distressing (visual analog scale >6) but 70 (73%) did not (visual analog scale <5). Eighty-four patients (85.7%) had clear recollection of their procedure (visual analog scale >6) and overall satisfaction was reported as good (visual analog scale >6) by 94.7%. Transnasal endoscopy can be adopted by clinicians competent with conventional esophagogastroduodenoscopy with expectation of high procedure completion rate and low complication rate. Our patients reported high levels of satisfaction with few reporting distress. Perhaps as a consequence, most patients had a clear recollection of their procedure.

Detachable string magnetically controlled capsule endoscopy for complete observation of the upper gastrointestinal tract.

Wireless magnetically controlled capsule endoscopy (WMCCE) was feasible, well tolerated, highly acceptable, and had high consistency in diagnosis of gastric diseases with esophagogastroduodenoscopy (EGD). But WMCCE is not suitable for inspection of the esophagus. We developed detachable string magnetically controlled capsule endoscopy (DS-MCCE) to observe gastroesophageal diseases. A total of 60 volunteers were enrolled. Thirty participants underwent DS-MCCE, and the other 30 underwent WMCCE. The primary outcome measures included swallowing time, esophageal transit time, the whole examination time, grade of air-bubble interference on esophageal, gastric preparation, visualization of Z-line and gastric mucosa, and discomfort scores. The esophageal time (222.53 ± 107.53 s vs. 49.50 ± 34.90 s, P < 0.001) and the whole examination time (26.53 ± 6.33 min vs. 15.97±4.90 min, P < 0.001) in DS-MCCE group were longer than in WMCCE group. DS-MCCE had a significantly better visualization of Z-line visualization. Visualization of the gastric mucosa was assessed as good in 24 (80%) participants for DS-MCCE and 26 (86.6%) for WMCCE, moderate in 6 (20%) with DS-MCCE as compared with 4 (13.3%) with WMCCE. The visualization of gastric cardia for DS-MCCE was better than for WMCCE (100 vs 80%, P = 0.024). The visualization of gastric angle, antrum, and pylorus in DS-MCCE group was not as good as in WMCCE group (80 vs. 100%, 80 vs. 100%, 83.3 vs. 100%, P = 0.024). DS-MCCE is feasible and well tolerated in the diagnosis of gastroesophageal diseases. For people who cannot stand conventional EGD or with contraindication of EGD, DS-MCCE may be an excellent alternative screening modality.

Usefulness of Full-spectrum Endoscopy for the Upper Gastrointestinal Tract.

We determined whether full-spectrum endoscopy (FUSE) improved the visualization rates of blind spots in a single-center case control study. FUSE provides a 210-degree angle of view with a left side-viewing camera in addition to a forward-viewing camera. FUSE can improve the detectability of blind spots in conventional forward-viewing esophagogastroduodenoscopy (EGD), such as the major duodenal papilla (MDP) and the anal side of the pyloric ring. Between April 2016 and May 2017, successful visualization rates of the whole MDP and anal side of the pyloric ring were compared between 103 participants who underwent FUSE and 1045 participants who underwent EGD. Pain and discomfort at insertion and during and after the examination were assessed using a visual analog scale in 38 participants who underwent FUSE with a previous examination history of EGD. The successful visualization rates of MDP and the anal side of the pyloric ring in the FUSE group were significantly higher than those in the conventional EGD group; 83.4% versus 35.1% for MDP (P<0.001) and 86.4% versus 7.1% for the anal side of the pyloric ring (P<0.001), respectively. The visual analog scale were not significantly different between FUSE and previous EGD in a portion of the FUSE group. In addition, the detection rate of the periampullary diverticula was also significantly higher in the FUSE group than that in the conventional EGD group (8.7% vs. 1.6%, P<0.001). This study provides evidence supporting that FUSE is superior to EGD for precise visualization of blind spots in the duodenum.

Acceptability to patients of screening disposable transnasal endoscopy: qualitative interview analysis

ObjectivesScreening in selected high risk populations for Barrett’s oesophagus (BO) and oesophageal varices (OVs) has been proposed, but there are obstacles with conventional oesophagogastroduodenoscopy (C-OGD), including patient acceptability. Portable and...

Acceptability, Accuracy, and Safety of Disposable Transnasal Capsule Endoscopy for Barrett's Esophagus Screening

Screening for Barrett's esophagus (BE) with conventional esophagogastroduodenoscopy (C-EGD) is expensive. We assessed the performance of a clinic-based, single use transnasal capsule endoscope (EG Scan II) for the detection of BE, compared to C-EGD as the reference standard. We performed a prospective multicenter cohort study of patients with and without BE recruited from 3 referral centers (1 in the United States and 2 in the United Kingdom). Of 200 consenting participants, 178 (89%) completed both procedures (11% failed EG Scan due to the inability to intubate the nasopharynx). The mean age of participants was 57.9 years and 67% were male. The prevalence of BE was 53%. All subjects underwent the 2 procedures on the same day, performed by blinded endoscopists. Patients completed preference and validated tolerability (10-point visual analogue scale [VAS]) questionnaires within 14 days of the procedures. A higher proportion of patients preferred the EG Scan (54.2%) vs the C-EGD (16.7%) (P < .001) and the EG Scan had a higher VAS score (7.2) vs the C-EGD (6.4) (P= .0004). No serious adverse events occurred. The EG Scan identified any length BE with a sensitivity value of 0.90 (95% CI, 0.83-0.96) and a specificity value of 0.91 (95% CI, 0.82-0.96). The EG Scan identified long segment BE with a sensitivity value of 0.95 and short segment BE with a sensitivity values of 0.87. In a prospective study, we found the EG Scan to be safe and to detect BE with higher than 90% sensitivity and specificity. A higher proportion of patients preferred the EG Scan to C-EGD. This device might be used as a clinic-based tool to screen populations at risk for BE. ISRCTN registry identifier: 70595405; ClinicalTrials.gov no: NCT02066233.

THE USE OF THE FORCEPS BIOPSY AS AN AUXILIARY TECHNIQUE FOR THE VISUALIZATION OF THE MAJOR DUODENAL PAPILLA USING THE FOWARD-VIEWING UPPER ENDOSCOPY.

- Conventional esophagogastroduodenoscopy is the best method for evaluation of the upper gastrointestinal tract, but it has limitations for the identification of the major duodenal papilla, even after the use of the straightening maneuver. Side-viewing duodenoscope is recommended for optimal examination of major duodenal papilla in patients at high risk for lesions in this region. To evaluate the use of the biopsy forceps during conventional esophagogastroduodenoscopy as an additional tool to the straightening maneuver, in the evaluation of the major duodenal papilla. A total of 671 patients were studied between 2013 and 2015, with active major duodenal papilla search in three endoscope steps: not straightened, straightened and use of the biopsy forceps after straightening. In all of them it was recorded whether: major duodenal papilla was fully visualized (position A), partially visualized (position B) or not visualized (position C). If major duodenal papilla was not fully visualized, patients continued to the next step. A total of 341 were female (50.8%) with mean age of 49 years. Of the 671 patients, 324 (48.3%) major duodenal papilla was identified in position A, 112 (16.7%) in position B and 235 (35%) in position C. In the 347 patients who underwent the straightening maneuver, position A was found in 186 (53.6%), position B in 51 (14.7%) and position C in 110 (31.7%). Of the 161 remaining patients and after biopsy forceps use, position A was seen in 94 (58.4%), position B in 14 (8.7%) and position C in 53 (32.9%). The overall rate of complete visualization of major duodenal papilla was 90%. The use of the biopsy forceps significantly increased the total major duodenal papilla visualization rate by 14%, reaching 604/671 (90%) of the patients (P<0.01) and it can be easily incorporated into the routine endoscopic examination of the upper gastrointestinal tract.

Endoscopic evaluation of celiac disease severity and its correlation with histopathological aspects of the duodenal mucosa.

Background and study aims: Celiac disease (CD) is a chronic systemic autoimmune disorder affecting genetically predisposed individuals, triggered and maintained by the ingestion of gluten. Triggered and maintained by the ingestion of gluten, celiac disease is a chronic systemic autoimmune disorder affecting genetically predisposed individuals. Persistent related inflammation of the duodenal mucosa causes atrophy architecture detectable on esophagogastroduodenoscopy (EGD) and histopathology. We investigated the association between endoscopic features and histopathological findings (Marsh) for duodenal mucosa in celiac disease patients and propose an endoscopic classification of severity. Patients and methods: Between January 2000 and March 2010, an electronic database containing 34,540 EDGs of patients aged > 14 years was searched for cases of CD. Out of 109 cases, 85 met the inclusion criteria: conventional EGD combined with chromoendoscopy, zoom and biopsy. EGD types 0, I and II corresponds to Marsh grades 0, 1 and 2, respectively, while EGD type III corresponds to Marsh grade 3 and 4. Results: Five patients (5.8 %) were EGD I but not Marsh grade 1; 25 patients (29.4 %) were EGD II, 4 of whom (16 %) were classified as Marsh grade 2; and 55 patients (64.7 %) were EGD III, 51 (92.7 %) of whom were classified as Marsh grades 3 and 4. The Spearman correlation coefficient (r = 0.33) revealed a significant association between the methods (P = 0.002). Conclusions: Changes in the duodenal mucosa detected on EGD were significantly and positively associated with histopathologic findings. The use of chromoendoscopy in addition to conventional EGD enhances changes in the duodenal mucosa and permits diagnosis of CD, even in routine examinations. The proposed endoscopic classification is practical and easily reproducible and provides valuable information regarding disease extension.

PTH-034 Blinded Comparison of Magnetically Assisted Gastric Capsule Endoscopy and Conventional Endoscopy in Recurrent and Refractory Iron Deficiency Anaemia: A Feasibility Study: Abstract PTH-034 Table 1

Introduction Magnetically assisted capsule endoscopy (MACE) of the stomach has been demonstrated to be safe and feasible.1 The aim of this prospective feasibility study was to compare the ability of MACE to recognise gastric landmarks compared to conventional flexible endoscopy in patients with recurrent or refractory iron deficiency anaemia. Methods Twenty patients with recurrent/refractory iron deficiency anaemia were enrolled between Jan-Nov 2015. After conventional oesophagogastroduodenoscopy, MACE was performed using MiroCam Navi (Intromedic, Seoul, Korea). Visualisation of major upper gastrointestinal landmarks was graded on a 1–5 scale (1 = poor, 5 = excellent), abnormalities were recorded. Primary outcome measure: gastric landmark recognition. Secondary outcome measures: pathology detection, patient tolerance. Results MACE achieved satisfactory visualisation (grade 4 or 5) in 11% for the gastro-oesophageal junction, 21% for the cardia, 16% for the fundus, 79% for the anterior wall of the gastric body, 79% for the posterior wall, 79% for the greater curvature, 84% for the lesser curvature, 95% for the antrum and 89% for the pylorus. 38 pathological findings were identified (Table 1). Patients experienced less pain, discomfort and distress during MACE compared to flexible endoscopy (p = 0.0009, p = 0.001 and p = 0.006 respectively). Conclusion MACE can visualise gastric landmarks, detect a variety of gastric pathology and is better tolerated than conventional endoscopy. Capsule identification of hiatal hernias is difficult and may improve with experience.2 Better oesophageal visualisation is possible with other models and it seems likely that Mirocam Navi could be developed to this end. Proximal gastric views may be more reliable using a double ended capsule, better depth of illumination, and perhaps with control of capsule movement, all of which need further study before MACE becomes a viable alternative to conventional endoscopy. References 1 Hale MF, Drew K, Sidhu R, McAlindon ME. Does magnetically assisted capsule endoscopy improve small bowel capsule endoscopy completion rate? A randomised controlled trial. Endosc Int Open. 2016 Feb; 4(2):E215–21. 2 Marelli L, Jaboli FM, Jackson L, Palmer H, Erian G, Hamilton M, Epstein O. A pilot study comparing ESO-2 capsule endoscopy with conventional upper endoscopy for the assessment of uncomplicated heartburn and dyspepsia. Frontline Gastroenterol201;4:96–101. Disclosure of Interest None Declared

Safety of unsedated PEG placement using transoral ultrathin endoscopy in patients with amyotrophic lateral sclerosis

Background and aims: In patients with amyotrophic lateral sclerosis (ALS), percutaneous endoscopic gastrostomy (PEG) placement under sedation often causes apnea or hypoventilation. The aim of the present study was to assess whether unsedated PEG placement in ALS patients using ultrathin endoscopy (UTE) via the transoral route can improve safety.Methods: Between 2003 and 2013, PEG placement was identified and reviewed in 45 patients with ALS. PEG was performed in 14 patients using transoral UTE without sedation (UTE group), 17 patients using conventional normal-diameter esophagogastroduodenoscopy (C-EGD) without sedation (unsedated C-EGD group) and 14 patients using C-EGD with sedation (sedated C-EGD group). We compared the clinical features, cardiopulmonary data before and during PEG placement, and complications related to PEG placement among the three groups.Results: There were no significant differences in age, male/female ratio, forced vital capacity, blood pressure, oxygen saturation before and during PEG, or major complications among the three groups. No minor complications were observed in the UTE group, whereas apnea and/or hypoventilation were observed in the sedated C-EGD group and aspiration pneumonia was observed in the unsedated C-EGD group.Conclusions: Unsedated PEG placement using transoral UTE in ALS patients is a safe method.

PTH-184 Superior patient preference and high diagnostic accuracy for the detection of barrett’s oesophagus using a novel, portable, probe-based transnasal endoscope

Introduction Barrett’s Oesophagus (BO) is the only recognised precursor to oesophageal adenocarcinoma. The second generation EG Scan™ system is portable with a disposable, ultrathin, probe-based imaging capsule; therefore it may be used in the community setting closer to the patient’s home. We aimed to compare the performance of unsedated transnasal endoscopy (TNE) using the EG Scan™ with conventional oesophagogastroduodenoscopy (C-OGD) for the detection of BO. Method This was a prospective, two-centre, diagnostic study with tandem design. Consecutive adult patients with histologically confirmed BO and those referred for assessment of reflux or dyspepsia were invited to participate. We excluded patients with recurrent epistaxis; nasal obstruction; and disease of the nasal cavity. All subjects underwent unsedated TNE (index test) followed by C-OGD (reference standard) on the same day, by two different operators blinded to the findings of each other. The primary outcome measure was the diagnostic accuracy for BO. In addition, procedure preference; tolerability (10-point visual analogue scale (VAS), 0 = worst and 10 = best); and adverse events questionnaires were administered on day 0 and day 14 after the procedures. Results 100 patients agreed to participate out of 439 subjects who were invited (22.8%). The mean age was 59.5 years (+/-13.7) and 63% were males. Prevalence of BO was 50%. 89 patients (89%) completed both procedures (11% failed TNE due to the inability to intubate the nasopharynx). Sensitivity, specificity and area under the receiver operating characteristic of TNE for the diagnosis of BO were 0.96 (95%confidence interval (CI) 0.85–0.99), 0.91 (95% CI 0.78–0.97), and 0.93 (95% CI 0.88–0.99), respectively. Patients reported higher preference for TNE compared to C-OGD on both day 0 (73.0% vs. 18.0%%, p Conclusion TNE using the EG Scan™ device was highly accurate for the detection of BO. More importantly, a significant majority of patients preferred TNE over C-OGD regardless of sedation use. The low test uptake could be due to the requirement for patients to undergo 2 procedures on the same visit. The EG Scan™ could potentially provide a true community-based screening tool for BO and oesophageal adenocarcinoma. Disclosure of interest None Declared.

Tu1529 Superior Patient Preference and High Diagnostic Accuracy for the Detection of Barrett's Esophagus Using a Novel, Portable, Probe-Based TransNasal Endoscope

Barrett's Esophagus (BE) is the only recognized precursor to esophageal adenocarcinoma. The second generation EG Scan™ system is portable with a disposable, ultrathin, probe-based imaging capsule; therefore it may be used in the community setting closer to the patient's home. We aimed to compare the performance of unsedated transnasal endoscopy (TNE) using the EG Scan™ with conventional esophagogastroduodenoscopy (C-EGD) for the detection of BE.

Unsedated Peroral Thin Scope Endoscopy for Screening of Esophageal Varices in Endoscopy-Naïve Child-Pugh A Cirrhotics

Introduction: Bleeding esophageal varices cause significant morbidity and mortality in patients with cirrhosis. While various non-invasive strategies for variceal screening have been proposed, current guidelines recommend conventional esophagogastroduodenoscopy (EGD). The drawbacks of this approach include cost and risk of adverse events. Therefore, we propose the use of unsedated peroral thin scope endoscopy (TSE) as an alternative, minimally-invasive strategy. Methods: We retrospectively reviewed the 168 endoscopy-naïve patients with Child-Pugh A cirrhosis who underwent TSE for variceal screening at the University of Calgary outpatient liver clinic between September 2011 and July 2013. Baseline characteristics collected included diagnosis, age, sex, AST, platelet count, spleen size, and liver stiffness by transient elastography (FibroScan®). The MELD score, platelet count to spleen ratio (PSR), AST to platelet ratio index (APRI), and liver stiffness-spleen diameter to platelet ratio score (LSPS) were calculated for each patient. The tolerability of TSE was recorded. Findings of TSE, including the presence and size of varices, and the presence of non-variceal phenomena, were documented. Results: TSE was well-tolerated in 94% of cases, and no adverse events were reported. The rates of no, small, and medium/large esophageal varices were 72.0%, 17.9%, and 10.1%, respectively. Medium/large varices with high-risk stigmata were seen in 1.8% of patients screened. Portal hypertensive gastropathy was seen in 36.3% of patients. Gastric or duodenal ulcers were seen in 13.7% of patients, but none warranted intervention. Patients with varices did not have higher MELD scores than those with no varices (p=0.48). LSPS was the single best noninvasive predictor of patients with medium/large esophageal varices (area under the receiver operating characteristic, 0.83; 95% confidence interval, 0.72-0.93; p<0.001). Conclusion: TSE for the screening of esophageal varices in endoscopy-naïve patients with Child-Pugh A cirrhosis is safe and well tolerated. Varices were found in 28% of patients, but most did not require further endoscopic intervention. In-hospital sedated EGD was avoided in 88% of patients screened. LSPS may be able to descriminate between patients suitable for TSE, and those who should proceed directly to EGD.

Esophageal capsule endoscopy is a useful tool in patients with hemophilia.

Esophageal capsule endoscopy (ECE) is considered to be an alternative to conventional esophagogastroduodenoscopy (EGD); however, its indications continue to expand. This report presents results from the use of ECE in patients with hemophilia at a tertiary referral academic center over a 7-year period. A total of 16 patients with hemophilia, who were all at risk of new-variant Creutzfeldt-Jakob disease due to previous treatment with UK plasma-derived pooled blood products, underwent a total of 28 ECE examinations. Main outcomes were the diagnostic yield of ECE, requirement for subsequent conventional EGD, and any variceal bleeding episodes during the follow-up period. The overall diagnostic yield was 67.8 % (19 /28 ECEs). Only one patient underwent conventional EGD, for esophageal biopsies. There were no variceal hemorrhage events in any of the patients on variceal screening follow-up. ECE is a useful and acceptable alternative to conventional endoscopy in selected patient groups (i. e. patients with hemophilia). In this group, ECE can eliminate the need for prior administration of clotting factors.

Diagnostic value of stringed esophageal capsule endoscopy for the esophageal diseases

Objective To investigate the diagnostic value of the modified esophageal capsule endos- copy （stringed esophageal capsule endoscopy, SCE） for esophageal diseases. Methods A total of 80 pa- tients with esophageal related symptoms underwent SCE followed by esophagogastroduodenoscopy （EGD）. The examination time, detection rate of esophageal lesions, complications and adverse effects were compared. Results All patients completed the study. The mean examination time of SCE and EGD was 226. 18 ＋ 110. 30 seconds and 21.28 ＋8.01 seconds respectively （t = - 16. 665, P =0. 000）. A total of 119 lesions were detected by SCE and EGD, and the diagnostic accordance rate of SCE and EGD was 82.4% （98/119）. Ten lesions of advanced squamous carcinoma, 5 lesions of high grade intraepithelial neoplasia and 3 lesions of early squamous carcinoma were detected by both examinations, all of which were confirmed by histopatho- logic examination. The overall rate of complication in SCE （ 1.3%, 1/80） was significantly lower than that of EGD （8.8%, 7/80, X2 = 4. 238, P = 0. 040） and the rates of swallow difficulty （ P = 0. 022）, throat dis- comfort （ P = 0. 007） and vomiting （ P = 0. 000） of SCE were significantly lower than those of EGD. Con- clusion SCE is a feasible, easy-to-operate, safe, well tolerated and accurate method for detection of esopha- geal diseases, and could be a non-invasive alternative for conventional EGD. Key words: Esophagus ; Diagnosis; Capsule endoscopy; String

A pilot study of single-use endoscopy in screening acute gastrointestinal bleeding

To investigate the feasibility of a single-use endoscopy as an alternative procedure to nasogastric lavage in patients with acute gastrointestinal (GI) bleeding. Patients who presented with hematemesis, melena or hematochezia were enrolled in this study. EG scan™ and conventional esophagogastroduodenoscopy (EGD) were subsequently performed. Active bleeding was defined as blood in the stomach, and inactive bleeding was defined as coffee ground clots and clear fluid in the stomach. The findings were recorded and compared. Between January and March, 2011, 13 patients that presented with hematemesis (n = 4), melena (n = 6), or bleeding from a previous nasogastric feeding tube (n = 3), were enrolled in this study. In 12 patients with upper GI bleeding, the EG scan device revealed that 7 patients had active bleeding and 5 patients had inactive bleeding, whereas conventional EGD revealed that 8 patients had active bleeding and 4 patients had inactive bleeding. The sensitivity and specificity of the EG scan device was 87.5% and 100% for active bleeding, with conventional EGD serving as a reference. No complication were reported during the EG scan procedures. The EG scan is a feasible device for screening acute upper GI bleeding. It may replace nasogastric lavage for the evaluation of acute upper GI bleeding.

Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy

To determine if esophageal capsule endoscopy (ECE) is an adequate diagnostic alternative to esophagogastroduodenoscopy (EGD) in pre-bariatric surgery patients. We conducted a prospective pilot study to assess the diagnostic accuracy of ECE (PillCam ESO2, Given Imaging) vs conventional EGD in pre-bariatric surgery patients. Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled. All patients underwent ECE followed by standard EGD. Two experienced gastroenterologists blinded to the patient's history and the findings of the EGD reviewed the ECE and documented their findings. The gold standard was the findings on EGD. Ten patients with an average body mass index of 50 kg/m(2) were enrolled and completed the study. ECE identified 11 of 14 (79%) positive esophageal/gastroesophageal junction (GEJ) findings and 14 of 17 (82%) combined esophageal and gastric findings identified on EGD. Fisher's exact test was used to compare the findings and no significant difference was found between ECE and EGD (P = 0.64 for esophageal/GEJ and P = 0.66 for combined esophageal and gastric findings respectively). Of the positive esophageal/GEJ findings, ECE failed to identify the following: hiatal hernia in two patients, mild esophagitis in two patients, and mild Schatzki ring in two patients. ECE was able to identify the entire esophagus in 100%, gastric cardia in 0%, gastric body in 100%, gastric antrum in 70%, pylorus in 60%, and duodenum in 0%. There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients.