Conventional Gastroscopy Research Articles

850 Prospective Blinded Study of a Magnetically Guided Gastric Capsule As Compared to Conventional Gastroscopy in Patients With Upper Abdominal Complaints

Upper GI endoscopy is mostly performed under sedation and has a low yield of relevant gastric lesions in patients without alarm symptoms. A simpler filter tests such as capsule endoscopy would be helpful, but current passive capsules do not provide adequate gastric visualization. The current study evaluates a magnetically guided capsule endoscopy (MGCE) in patients with routine indications for gastroscopy.

Diagnostic validity of CT gastrography versus gastroscopy for primary lesions in gastric cancer: evaluating the response to chemotherapy, a retrospective analysis

This retrospective study was carried out to compare computed tomographic (CT) gastrography and conventional optical gastroscopy (GS) in order to evaluate the effectiveness of chemotherapy in primary gastric lesions. Patients with unresectable advanced and unresected early gastric cancer who had primary lesions and had received chemotherapy were enrolled. For primary lesions, CT gastrography and endoscopic assessment were done after chemotherapy, based on the Japanese Classification of Gastric Carcinoma (JCGC) criteria, 13th edition, and the Response Evaluation Criteria in Solid Tumors (RECIST). For metastatic solid lesions including lymph nodes, CT assessment was done based on the RECIST criteria. Data from 23 patients were analyzed. With median follow-up of 9.4 months (range 2-23 months), 58 examinations were assessed by GS and CT gastrography. Setting optical endoscopic results as the gold standard, the accuracy of CT gastrography for primary gastric lesions was 77.6 % (45 of 58) (weighted κ = 0.72; P < 0.01) according to the JCGC 13th edition criteria and 90.0 % (52 of 58) (weighted κ = 0.75; P < 0.01) according to the RECIST. When all results were divided into two groups [the non-progressive disease (non-PD) group and PD group], accuracy was 93.1 % (52 of 58) (κ = 0.81; P < 0.01), sensitivity was 100 %, and specificity was 75.0 % (12 of 16). In addition, the predictability of PD was 100 % (12 of 12). The four cases of failure in specification were the following: a case of gastric remnant cancer, a case with insufficient distension of the stomach, a healed case with stenosis and scarring, and a case in which the wrong position had been selected for the examination. The average period until PD was 9.9 months (range 5-18 months), and the concordance period between GS and CT gastrography was 7.2 months in both non-PD and PD cases. There was good concordance between the evaluations of GS and CT gastrography. CT gastrography exhibited favorable results in accuracy as well as 100 % PD predictability, which implied the possibility of using CT gastrography as a substitute for endoscopic assessments at post-chemotherapy assessments.

High Levels of Aromatic Amino Acids in Gastric Juice during the Early Stages of Gastric Cancer Progression

BackgroundEarly-stage gastric cancer is mostly asymptomatic and can easily be missed easily by conventional gastroscopy. Currently, there are no useful biomarkers for the early detection of gastric cancer, and their identification of biomarkers is urgently needed.MethodsGastric juice was obtained from 185 subjects that were divided into three groups: non-neoplastic gastric disease (NGD), advanced gastric cancer and early gastric cancer (EGC). The levels of aromatic amino acids in the gastric juice were quantitated using high-performance liquid chromatography.ResultsThe median values (25th to 75th percentile) of tyrosine, phenylalanine and tryptophan in the gastric juice were 3.8 (1.7–7.5) µg/ml, 5.3 (2.3–9.9) µg/ml and 1.0 (0.4–2.8) µg/ml in NGD; 19.4 (5.8–72.4) µg/ml, 24.6 (11.5–73.7) µg/ml and 8.3 (2.1–28.0) µg/ml in EGC. Higher levels of tyrosine, phenylalanine and tryptophan in the gastric juice were observed in individuals of EGC groups compared those of the NGD group (NGD vs. EGC, P<0.0001). For the detection of EGC, the areas under the receiver operating characteristic curves (AUCs) of each biomarker were as follows: tyrosine, 0.790 [95% confidence interval (CI), 0.703–0.877]; phenylalanine, 0.831 (95% CI, 0.750–0.911); and tryptophan, 0.819 (95% CI, 0.739–0.900). The sensitivity and specificity of phenylalanine were 75.5% and 81.4%, respectively, for detection of EGC. A multiple logistic regression analysis showed that high levels of aromatic amino acids in the gastric juice were associated with gastric cancer (adjusted β coefficients ranged from 1.801 to 4.414, P<0.001).ConclusionIncreased levels of tyrosine, phenylalanine and tryptophan in the gastric juice samples were detected in the early phase of gastric carcinogenesis. Thus, tyrosine, phenylalanine and tryptophan in gastric juice could be used as biomarkers for the early detection of gastric cancer. A gastric juice analysis is an efficient, economical and convenient method for screening early gastric cancer development in the general population.

Narrow band imaging versus white light gastroscopy in detecting potentially premalignant gastric lesions: a randomized prospective crossover study

Narrow band imaging (NBI) detects mucosal surface details (pit pattern) as well as the microvasculature pattern of mucosa. In premalignant conditions the pattern and regularity of pits and microvasculature are altered. We aimed to assess whether NBI is superior to conventional white light gastroscopy (WLG) in detecting potentially premalignant gastric lesions. We conducted a randomized prospective crossover study from January 2009 to July 2009. Patients above 45years of age with dyspepsia in absence of alarm symptoms underwent gastric mucosal examination using WLG and NBI in the same session by different endoscopists who were blinded to each other's endoscopy findings. Biopsy was taken if required at the end of the second gastroscopy after a third observer reviewed reports of both scopists. The yield of gastric potentially premalignant lesions (atrophic gastritis, intestinal metaplasia, dysplasia, adenomatous polyp) was compared for both procedures. Two hundred [mean age 52.3 (6.4) years, males-66%] patients participated in the study. Thirty-two patients were diagnosed to have potentially premalignant lesions using both modalities. No patient had early gastric cancer. WLG detected lesions in 17 patients (atrophic gastritis in 12, atrophic gastritis with intestinal metaplasia in 5) and NBI in 31 patients (atrophic gastritis in 22, atrophic gastritis with intestinal metaplasia in 9). The sensitivity of lesion detection by NBI was significantly higher than WLG (p = 0.001). NBI was superior to WLG for detection of atrophic gastritis and intestinal metaplasia.

Mo2085 Feasibility Study of a Haptic Interface in Magnetically Guided Capsule Endoscopy for Palpation Inside the Human Stomach

Magnetically guided capsule endoscopy (MGCE) was introduced in 2010 (Endoscopy 2010;42:541). A capsule endoscope with a magnet inside is steered through the water-filled stomach by externally generated magnetic fields using 2 joysticks. Currently, the operator only uses visual feedback for navigation as in conventional gastroscopy. With an investigated future integration of additional sensors for relative or absolute position tracking of the capsule a new feedback method becomes available. By integrating a haptic joystick device into the system, it is possible to control the capsule movements and additionally “feel” the forces acting on it. It allows feeling the shape of the stomach and mucosa as well as the pressure the capsule puts on it. This is a key to a new navigation method and a variety of new diagnosis and treatment procedures. We sought to prove the feasibility of a new haptic control and feedback method for navigation and diagnosis in the human stomach using MGCE. In an MGCE simulation, we integrated sensors for absolute and relative position tracking of the capsule and interfaced a haptic device “omega.7” by Force Dimension (Lausanne, Switzerland). The device allows forces to be felt in all 3 spatial dimensions. Based on this, we developed different control designs and algorithms to calculate suitable haptic forces. Virtual examinations were performed in repeated trials to measure performance in means of completeness of the examination and intuitive control. Two control designs were selected: (1) Control relative to camera view, for example, a horizontal joystick shift forward moves the capsule towards its current view; and (2) control relative to MGCE coordinate system, for example, any horizontal joystick shift moves the capsule in the coronal plane of a patient in supine position. Both designs had completeness results at the same level as the conventional control. Although design 1 was more intuitive with the camera view present, design 2 allowed an additional blind navigation without a camera. The mucosa wall and structure could be felt clearly with the haptic output, but the quality heavily relied on sample rate and accuracy of the sensors. The method proved feasible for MGCE in a simulator with different pathologies like lymphomas or ulcers. A variety of new diagnosis and treatment procedures become available: (1) Perform palpation inside the stomach; (2) feel the strength of stomach contractions and the effect it has on the capsule; (3) guide a blind capsule holding sensors other than cameras (eg, electrochemical or spectroscopic sensors); and (4) control and feel the pressure of a tool attached to a capsule for possible new MGCE intervention procedures.

Diagnostic value of endoscopic ultrasonography for large gastric folds

Objective To evaluate endoscopic ultrasonography （EUS） for diagnosis of large gastric folds. Methods EUS was performed in 66 patients with possible large gastric folds which could not be diag- nosed by conventional gastroscopy. The characteristics of EUS findings were analyzed, and the EUS results were compared with pathological findings to evaluate the sensitivity, specificity and accuracy of EUS. Re- suits The diagnostic sensitivity, specificity and accuracy of EUS for diffused infiltrated gastric cancer were 92. 3% （24/26）, 95.1% （39/41） and 95.5% （63/66）, respectively, and those for gastric lymphoma were 92. 3% （12/13）, 96. 1% （49/51） and 92. 4% （61/66）, respectively. The accuracy in differential diagno- sis of benign and malignant disease was 93.9% （62/66）. There were statistical differences between benign and malignant large gastric folds in characteristics of EUS findings, including width of gastric wall, enlarge- ment of muscularis propria and preservation of gastric layer （P 〈 0. 05 ）. Conclusion EUS is of high accu- racy for diagnosis of large gastric folds, especially for diffused infiltrated gastric cancer and gastric lympho- ma. Such features as width of gastric wall, the enlargement of muscularis propria and the preservation of gas- tric layer are important features for differential diagnosis of benign and malignant lesions. Key words: Endoscopic ultrasonography; Large gastric folds

Endoscopic ultrasonography in diagnosis of duodena] cysts

Objective To investigate the diagnostic value of endoscopic ultrasonography （EUS） for duodenal cysts. Methods Clinical manifestations, results of conventional gastroscopy and EUS, as well as follow-up, of patients with duodenal cysts were retrospectively analyzed. Results A total of 105 patients with duodenal cysts presented with no lesion-related symptoms, but displayed characteristic imaging changes under EUS, which could reveal the origin, size and nature of duodenal cysts, and differentiate it from other submucosal lesions. A maximum follow-up of 5 years showed no changes in duodenal cysts. Conclusion Duodenal cyst is a benign disease, and EUS plays a very important role in diagnosis of the disease. Key words: Endoscopic uhrasonography ; Duodenal cyst ; Diagnosis ; Treatment

The value of endoscopic ultrasonography for management of esophageal leiomyoma

Objective To investigate clinical value of endoscopic ultrasonography (EUS) on diagnosis and treatment of esophageal leiomyoma.Methods The clinical feature of patients diagnosed as esophageal leiomyoma by EUS was analyzed.All patients underwent conventional gastroscopy and EUS examination as well as blood test.The EUS findings were compared with histopatholoical diagnosis for endoscopically or surgically resected specimens.All patients were followed-up with EUS for 14.3 months (range 2-36 months) for leiomyoma recurrence.Results A total of 191 patients were diagnosed with esophageal leiomyomas by EUS.Clinical manifestation,serum examination,conventional gastroscopy and spiral CT were not helpful for diagnosing esophageal leiomyoma,One hundred and sixteen patients with esophageal leiomyomas were treated by either endoscopic resection (111 cases) or surgical excision (5 cases).of which,101 resected specimens were pathologically confirmed as leiomyomas.The diagnostic accuracy of EUS was 87%.The follow-up study showed that there was no change of leiomyomas in 75 untreated patients and no recurrence was found in 116 surgically treated patients.Conclusion Esophageal leiomyoma is a benign tumor,EUS plays a very important role in diagnosis and treatment of this disease. Key words: Esophageal leiomyoma; Endoscopic ultrasonography; Diagnosis

Das Adenokarzinom des Duodenums

Primary duodenal adenocarcinoma are rare. We report a case of a 65-year-old woman with iron deficiency anaemia that was referred to our department for endoscopic small bowel investigation. Prior to admission the patient had undergone ambulatory bidirectional endoscopy which had detected no abnormalities. Before examining the small intestine a conventional gastroscopy was performed. By using the full length of the instrument an adenocarcinoma with subtotal tumour stenosis was diagnosed located in the second portion of the duodenum. CONCLUSION: In the examination of obscure iron deficiency anaemia gastroscopy represents a cost-effective and reliable diagnostic method. In order to prevent higher costs caused by elaborate investigation of the small intestine it makes sense to tap the full potential of conventional endoscopy. Especially when performing gastroscopy the scope should always be introduced to its maximum length. Nevertheless it is a useful measure to replicate “second look endoscopy”. In the present case of primary duodenal adenocarcinoma crucial prognostic factors include radical resection, the number of examined lymph nodes and absence of metastases.

Quantitative measurement of gastric mucosal microcirculation using a combined laser Doppler flowmeter and spectrophotometer

Anastomotic leakage after esophagectomy and esophagogastrostomy depends on the vascularization of the gastric conduit. So far, no adequate methods are available to monitor postoperatively mucosal microcirculation of the gastric conduit. The aim of this experimental study was to assess a recently developed microprobe with a microlight-guide spectrophotometer (O2C, Fa. LEA Medizintechnik, Giessen, Germany) to quantitatively measure gastric mucosal blood flow (MBF) and mucosal oxygen saturation (MOS) of different gastric areas. Eighteen patients without gastric pathology were included in this study. During conventional gastroscopy the microprobe was introduced via the working channel of a standard endoscope and positioned in well-defined areas of the antrum and fundus. The tip of the microprobe consisted of a combined laser Doppler and tissue spectrometer measuring continuously the MBF (perfusion units, PU) and MOS (SO(2), in %). The mean MOS of the antrum was significantly higher compared with the fundus (antrum: 82% +/- 7.9 standard deviation [SD], fundus: 72% +/- 10.4; P = 0.0002). The mean MBF was not significantly different between antrum and fundus (antrum: 201 PU +/- 40 SD, fundus: 223 PU +/- 29 SD). This study demonstrates the feasibility of the gastric O2C microprobe to measure parameters of gastric microcirculation from the endoluminal side.

The future of wireless capsule endoscopy

We outline probable and possible developments with wireless capsule endoscopy. It seems likely that capsule endoscopy will become increasingly effective in diagnostic gastrointestinal endoscopy. This will be attractive to patients especially for cancer or varices detection because capsule endoscopy is painless and is likely to have a higher take up rate compared to conventional colonoscopy and gastroscopy. Double imager capsules with increased frame rates have been used to image the esophagus for Barrett's and esophageal varices. The image quality is not bad but needs to be improved if it is to become a realistic substitute for flexible upper and lower gastrointestinal endoscopy. An increase in the frame rate, angle of view, depth of field, image numbers, duration of the procedure and improvements in illumination seem likely. Colonic, esophageal and gastric capsules will improve in quality, eroding the supremacy of flexible endoscopy, and become embedded into screening programs. Therapeutic capsules will emerge with brushing, cytology, fluid aspiration, biopsy and drug delivery capabilities. Electrocautery may also become possible. Diagnostic capsules will integrate physiological measurements with imaging and optical biopsy, and immunologic cancer recognition. Remote control movement will improve with the use of magnets and/or electrostimulation and perhaps electromechanical methods. External wireless commands will influence capsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However, it should be noted that speculations about the future of technology in any detail are almost always wrong.

Imaging of Various Gastric Lesions with 2D MPR and CT Gastrography Performed with Multidetector CT

Recent advances in computed tomographic (CT) technology, three-dimensional imaging software, and cheaper data storage capacity have made faster, simpler, and more accurate gastric imaging available. Two-dimensional multiplanar reformation and CT gastrography including virtual gastroscopy and transparency rendering allow multiplanar cross-sectional imaging, gastroscopic viewing, and upper gastrointestinal series imaging in the same data acquisition. Multi-detector row CT allows noninvasive assessment of the gastric wall and the perigastric extent of disease. It is also helpful in detection and evaluation of gastric malignancies and a variety of inflammatory conditions that affect the stomach. Conventional gastroscopy provides the most useful information about the exact location of the lesion and also allows performance of biopsy. Endoscopic ultrasonography (US) provides the most useful information about horizontal extension of the tumor, the depth of mural invasion, and perigastric lymphadenopathy. However, endoscopic US has not been able to replace CT for tumor staging because of its limitations in demonstrating distant lymphadenopathy or metastatic deposits.

Early gastric cancer: virtual gastroscopy

Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer-related deaths worldwide. Early detection and accurate preoperative staging of early gastric cancer (ECG) offers the best prognosis and is essential for planning optimal therapy such as endoscopic mucosal resection or gastric resection. Recent advances in computed tomographic technology and three-dimensional imaging software have enabled more accurate gastric imaging. Virtual gastroscopy (VG) is helpful in the detection and evaluation of EGC in the same way as gastroscopy. VG has a wider field of view than conventional gastroscopy, the angle of the virtual cancer can be adjusted omnidirectionally, and it has no blind point because retrospective reconstruction is available. Thus, VG is a promising method for evaluating gastric lesions despite its limitations. This report describes the clinical usefulness of VG with multidetector row computed tomography for EGC and axial computed tomography.

Comparison of Two-dimensional CT with Virtual Gastrography Using Multi-detector CT in the Diagnosis of Early Gastric Cancer

Purpose: We compared the performance of virtual gastrography (VG) using multi-detector (MDCT) with twodimensional (2D) CT in the diagnosis of early gastric cancer (EGC). Materials and Methods: We performed conventional gastroscopy and MDCT examination after gaseous distension of the stomach in 50 consecutive patients who were confirmed as EGC by surgery and endoscopic mucosal resection. Unenhanced images were obtained in the prone position and contrast enhanced images were obtained in the supine position. Contrast enhanced imaging was done 70 seconds after intravenous injection of 150 mL of ionic contrast material at the rate of 3 mL/sec. 2D CT and VG images were analyzed by two radiologist with consensus to assess the location and gross morphologic type of EGC. Crosstabs were used to determine the diagnostic accuracy of EGC on 2D CT and VG. Results: The diagnostic specificity for 50 patients with EGC was significantly higher with VG (72%) than with 2D CT (88%) (p

Using the Video Endoscope Prototype Olympus XGIF-N160Y1 for Transnasal Gastroscopy: A Pilot Study of Feasibility and Tolerability

Background and Aim: The video endoscope Olympus XGif-N160Y1 (outer diameter:4.9 mm, total length:1410 mm, working length:1100 mm) is a prototype (PT) with only “up-down” movement, metallic distal tip and a deflexion capability of 210° up and 180° down. The aim of the study was to assess feasibility and tolerability of transnasal gastroscopy (TN) using this prototype. Methods: 50 consecutive patients eligible for TN were enrolled in the study (25 men, 25 female, age: 49 ± 17 years). InIclusion criteria were: indication for gastroscopy, history of prior conventional gastroscopy and age>14 years.

Magnetic Resonance Imaging Gastrography

We sought to demonstrate the feasibility of depicting gastric tumors using magnetic resonance imaging (MRI) while applying the dark lumen technique. The findings were correlated with conventional gastroscopy. In addition, we evaluated the screening for lymph nodes and liver metastases during the same session to identify potential tumor spread. The study included 15 patients with known malignant gastric disease. Conventional gastrointestinal endoscopy was performed in all patients as gold standard. All patients were examined with computed tomography for tumor staging. MRI was performed using 1 L of tap water as oral contrast agent for all protocols. The MRI program included an axial T1-weighted (T1w; 2D-FLASH) sequence, an axial STIR and T2w (TSE) sequence, and 2 postcontrast T1w (3D coronal /2D axial FLASH) sequences using 0.2 mmol/kg gadolinium diethylenetriaminepenta-acetic acid as intravenously injected contrast agent. Qualitative analysis and comparison with conventional gastroscopy were performed. The images obtained with the postcontrast 3D coronal T1w-FLASH sequence were the most suitable in identifying gastric tumors. Complete correlation with conventional gastroscopy was achieved in 80% of the cases and partial correlation in 13% of the cases. The same imaging sequence was also appropriate for the evaluation of lymph nodes. For the identification of liver metastases, the images obtained with the axial postcontrast T1w 2D-FLASH sequence provided a higher diagnostic confidence as compared with other imaging protocols. Applying the dark lumen technique through MRI is suitable for imaging gastric tumors and has the potential to become a "one-stop shopping" method because of the possibility for lymph node evaluation and screening for metastases during the same session based on the same images.

Transnasal gastroscopy is less expensive than conventional gastroscopy: A cost analysis

Transnasal gastroscopy is less expensive than conventional gastroscopy: A cost analysis

7116 Unsedated trans-nasal gastroscopy in 1000 patients: feasibility, safety, tolerance and cost-effectiveness.

Background: Conventional gastroscopy (CG)is considered as a traumatic examination by the patients and expensive for National Health Care Service. Previous studies have demonstrated unsedated trans-nasal gastroscopy (TG) is feasible and well-tolerated. Aim: to compare the feasibility, safety, tolerance and cost-effectiveness of TG versus CG. Methods: Between September 1998 and June 1999,1000 patients (M/F ratio: 480/520; age range 12-95 years)were submitted to unsedated TG (Pentax fiberoptic endoscope FG-16V, 5 mm in diameter), half of them performed both CG at first examination and TG at follow-up. Oxygen saturation was measured during the procedure by Minolta-pulsox oxymeter. Patients' tolerance (discomfort, nausea, vomiting, choking)was assessed on visual analogue scales. Direct and indirect costs were considered for cost-analysis. Results: Unsedated TG was feasible in 978 patients (97.8%), in 2.2 % the examination failed for anatomical reasons. Mean time taken for TG was 3 +/- 1 minutes. No complications were observed. Oxygen saturation did not change during TG. TG was more acceptable and less uncomfortable to the patients than CG, results are in the table. Cost-analysis showed that TG is three times less expensive than CG. Total amount of direct and indirect costs for the former is of Euro 85.96 versus Euro 220.61 for the latter. Conclusions: TG is feasible, safe and well tolerated by patients. Eighty-four percent of patients were willing to undergo unsedated TG in the future. Among patients submitted to both TG ang CG 90% would choose TG for further examinations. By reducing consumable and pharmaceutical costs, and eliminating the need for sedation -related work-loss and post-procedural monitoring, TG is more cost-effective than CG. Analogue visual scale (0-10) TG CG total 0-3 435* 50 485 >3 55 440 495 total 490 490 980 * p=

A simplified technique for percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) is the preferred method of establishing long-term enteral access for feeding. Many patients requiring PEG are elderly and at risk for complications. Expeditious placement of the gastrostomy tube will minimize complications, but distorted esophageal anatomy can significantly lengthen the procedure. Some endoscopists abandon conventional repeat gastroscopy in difficult cases to accelerate the procedure. The authors describe a reliable method for quick reinsertion of the endoscope which shortens time required for PEG, and may reduce complications.

Sonoendoscopic evaluation of extraesophageal and extragastric abnormalities: a review.

A conventional fiberoptic gastroscope was modified to incorporate a 9-MHz transducer 7 cm from the tip. Conventional fiberoptic gastroscopy could be performed simultaneously with sonoendoscopic evaluation of the esophagus and gastric, extraesophageal, and extragastric areas. The instrument was utilized to evaluate intra- and extra-luminal abnormalities of the mediastinum and upper abdomen. This paper presents our data on extraluminal disease. Small hepatic and pancreatic tumors were identified, occasionally with more accuracy than conventional imaging studies. Additionally, mediastinal tumors, gastrointestinal tumors, and cardiac abnormalities were also clearly demonstrated.