Endoscopy In Patients Research Articles

Mo1110 PATIENT AND ENDOSCOPIST SATISFACTION WITH NURSE ADMINISTERED PROPOFOL CONTINUOUS INFUSION SEDATION: A COMPARATIVE STUDY AGAINST MIDAZOLAM/FENTANYL AND COMPUTER ASSISTED PROPOFOL SEDATION

As the first U.S. center to adopt computer assisted propofol sedation (CAPS) for routine clinical use, we found it to be an effective, efficient and safe method to administer sedation that was very well received by our patients, nurses and endoscopists. After the closure of the CAPS manufacturer in 2016, we developed Nurse Administered Propofol Continuous Infusion Sedation (NAPCIS), a method to replicate the CAPS dosing protocol in the absence of the CAPS device. NAPCIS is a propofol delivery method that uses a standard IV infusion pump controlled by a trained nurse, with a dosing and safety protocol identical to that used in CAPS. Instead of small, intermittent propofol boluses, a continuous infusion is given after a single fentanyl premedication dose. This abstract reports patient and endoscopist satisfaction with NAPCIS compared against 2 control groups - CAPS and midazolam/fentanyl (MF) sedation. Patients who underwent elective outpatient upper endoscopy and colonoscopy with NAPCIS over a 2 month period were compared against historical controls sedated with MF or CAPS. All endoscopy was performed by 1 of 19 specially trained gastroenterologists. Patient satisfaction was measured by the validated 19-item Patient Sedation Satisfaction Index (PSSI), and endoscopist satisfaction by the 21-item Clinician Sedation Satisfaction Index (CSSI); the PSSI and CSSI incorporate subscores for the assessment of sedation adequacy, ease of sedation administration, the recovery process and global satisfaction. Normalized satisfaction scores (scale of 1-100) were compared between NAPCIS and CAPS or MF controls, stratified by procedure type. Procedural success rates, polyp detection rates, adverse events, and procedure/recovery times are reported in a separate abstract. NAPCIS was used to sedate 236 patients (mean age 57.8 years; 48.5% male), of whom 46 underwent upper endoscopies and 190 colonoscopies. Their satisfaction scores were compared against 298 MF and 228 CAPS controls. For both colonoscopy and upper endoscopy, the NAPCIS group had higher PSSI subscores than the MF controls for sedation adequacy, the recovery process, and global satisfaction (Table 1), and much higher CSSI subscores for ease of sedation administration, the recovery process, and global satisfaction (Table 2). PSSI scores were comparable between NAPCIS and CAPS for colonoscopy but were higher for NAPCIS for upper endoscopy (data not shown). CSSI scores were significantly higher for NAPCIS compared against CAPS for both upper endoscopy and colonoscopy (data not shown). Compared against MF, NAPCIS is associated with uniformly higher patient and endoscopist satisfaction for both upper endoscopy and colonoscopy. Compared against CAPS, NAPCIS is associated with higher patient and endoscopist satisfaction for upper endoscopy but not for colonoscopy.Tabled 1Table 1. PSSI subscores: NAPCIS vs MF (higher scores denote higher satisfaction)EGDColonoscopyNAPCISMFPNAPCISMFPSedation Adequacy97.291.7<0.00196.889.9<0.001Recovery Process96.492.4<0.00194.590.1<0.001Global Satisfaction97.995.40.03396.393.7<0.001 Open table in a new tab Tabled 1Table 2. CSSI subscores: NAPCIS vs MF (higher scores denote higher satisfaction)EGDColonoscopyNAPCISMFPNAPCISMFPEase of Sedation Administration95.781.8<0.00198.085.2<0.001Recovery Process97.769.2<0.00198.175.4<0.001Global Satisfaction94.878.6<0.00198.083.8<0.001 Open table in a new tab

Procedural sedation by advanced care paramedics for emergency gastrointestinal endoscopy.

At the QEII Health Sciences Centre Emergency Department (ED) in Halifax, Nova Scotia, advanced care paramedics (ACPs) perform procedural sedation and analgesia (PSA) for many indications, including orthopedic procedures. We have begun using ACPs as sedationists for emergent upper gastrointestinal (UGI) endoscopy. This study compares ACP-performed ED PSA for UGI endoscopy and orthopedic procedures in terms of adverse events, airway intervention, vasopressor requirement, and PSA medication use. A data set was built from an ED PSA quality control database matching 61 UGI endoscopy PSAs to 183 orthopedic PSAs by propensity scores calculated using age, gender, and the American Society of Anesthesiologists (ASA) classification. Outcomes assessed were hypotension (systolic BP30 sec), vomiting, arrhythmias, death, airway intervention, vasopressor requirement, and PSA medication use. UGI endoscopy patients experienced hypotension more frequently than orthopedic patients (OR=4.11, CI: 2.05-8.22) and required airway repositioning less often (OR=0.24, CI: 0.10-0.59). They received ketamine more frequently (OR=15.7, CI: 4.75-67.7) and fentanyl less often (OR=0.30, CI: 0.15-0.63) than orthopedic patients. Four endoscopy patients received phenylephrine, and one required intubation. No patient died in either group. In ACP-led sedation for UGI endoscopy and orthopedic procedures, adverse events were rare with the notable exception of hypotension, which was more frequent in the endoscopy group. Only endoscopy patients required vasopressor treatment and intubation. We provide preliminary evidence that ACPs can manage ED PSA for emergent UGI endoscopy, although priorities must shift from pain control to hemodynamic optimization.

Mycobacterium avium lysate induces matrix metalloproteinase-1 in intestinal tissue and peripheral blood: Observations from selected hospital based Zambian adults

ObjectivesEnvironmental enteropathy is prevalent in low-income countries, although its aetiology is unknown. We investigated if Mycobacterium avium antigens, which are commonly found in the environment, could contribute to its pathogenesis in a population known to have widespread environmental enteropathy. MethodsRoutine endoscopy patients at the University Teaching Hospital, Lusaka whose endoscopy results were normal submitted duodenal biopsies and whole blood samples. Samples were stimulated with M. avium lysate over 24h while unstimulated samples served as negative controls. Matrix metalloproteinase (MMP) and cytokine response in supernatants were quantified using ELISA and cytometric bead array. ResultsSamples from 48 patients (56% women) were analysed, with a median age of 35 years (IQR 27.5, 50.5). M. avium induced the secretion of a wide-range of Th1, Th2 and Th17 cytokines in blood but only IL-1β and IL-6 in duodenal tissue. However it differentially induced the secretion of MMP-1 in duodenal tissue compared to negative controls (p=0.004). A similar MMP-1 response but with lower concentrations was observed in blood. ConclusionThe induction of MMP-1 and cytokines by M. avium in duodenal tissue suggests that environmental mycobacteria could contribute to the epithelial disruption seen in environmental enteropathy, and a need to further explore possible biomarkers that may predict this exposure in at-risk populations.

Dyspepsia among Endoscopy Patients in Two Major Hospitals in Jordan: Correlation with Psychological and Lifestyle Disorders

Background: Dyspepsia is a common complaint, considered as one of the gastrointestinal disorders having a great unfavourable impact on the economic status for countries and individuals, work productivity and quality of life.Objectives: The aims of this study are: to estimate the prevalence of dyspepsia among a convenient sample of patients referred for upper endoscopy, to determine the association between dyspepsia and selected different lifestyle and demographic variables, to find out the relationship between dyspepsia and psychological disturbance, and to estimate the prevalence of positive endoscopic findings in comparison to normal (negative) endoscopy.Materials and Methods: A cross sectional study included a convenient sample of 460 patients aged 15 or above. Data were analysed and statistical significance determined by Chi- square test at level (P≤ 0.05).Results: Out of 460 patients, 443 filled the questionnaire completely. The prevalence of dyspepsia among the sample was 59.6%. Among the dyspeptics, endoscopic results showed that functional dyspepsia was more prominent than organic dyspepsia. Variables significantly associated with dyspepsia according to Rome IV criteria were: Age (P= 0.001), income (p= 0.02), psychological disturbance as stress, anxiety and depression (p=0.001 for each), previous GIT consultation or medication (p=0.001) and H. pylori infection (p=0.001).Conclusions and Recommendations: Dyspepsia is associated with a variety of factors. Functional dyspepsia could be prevented by working on lifestyle habits modification and giving more attention towards psychological conditions of patients. Healthcare professionals recommended to identify patient’s history more carefully and to proceed with more investigation that is gradual procedures.International Journal of Human and Health Sciences Vol. 02 No. 02 April’18. Page : 78-86

Clinical and manometric profile of patients with GERD in a tertiary care hospital

Background: Abnormal esophageal motility and low Lower Esophageal Pressure (LES) play an integral role among various etiologies implicated in pathogenesis and severity of Gastro Esophageal Reflux Disease (GERD). Delayed clearance of refluxate leads to prolonged mucosal exposure to gastro duodenal contents which promotes esophagitis and its complications. To find out the association of ineffective esophageal motility (IEM) and low Lower Esophageal Sphincter (LES) pressure with endoscopic esophagitis in patients presenting with symptoms of GERD. Settings and designs: Prospective cross sectional study done in a tertiary medical care center in south India from October 2016 to March 2017.Methods: This cross sectional study was carried out among patients presenting with symptoms of GERD (heart burn and regurgitation,) at least twice per week for past three months. Based on their endoscopy findings patients with GERD are grouped into two having erosive and nonerosive reflux disease. After general and systemic clinical examination, High resolution Manometry was performed, and data was analyzed using Trace 1.2.3a V software. Statistical methods: Data was analysed using SPSS version 19. Chi square test was used to analyze categorical variables and independent ’t’ test was used for continuous variables.Results: A total of 66 patients with GERD symptoms were subjected to esophageal manometry. Out of these 66 patients 42 were males and 22 were females with their mean age 40.82±12.86 years. Among 66 patients presented with GERD symptoms 26.7% were found to have ineffective esophageal motility and only 11.7% had low LES pressure. Ineffective esophageal motility was also found to be more common among older age group individuals with their mean age being 44.64 ±14.154. Among the patients with erosive reflux disease (70.21%), 66.7% had low LES pressure and 75 % had IEM; the association was not statistically significant.Conclusions: The incidence of Ineffective esophageal motility in patients with GERD is found to be higher than that of low LES pressure. There was no significant association observed between IEM and low LES pressure with endoscopic esophagitis in patients with GERD.

A Single Centre Retrospective Review of Colorectal Cancer in Trinidad over a Three Year Period

Aim To determine the demographics of patients with endoscopic diagnosis of colorectal cancer and the site of lesion Method A retrospective study of endoscopic diagnosis of colorectal cancer in patients at the Port of Spain General Hospital Results The mean age of patients was of patients were female Only of patients were below the age of Left sided tumors were more common than right sided ones The main reasons for referring the patient for a lower GI endoscopy was suspected cancer GI bleed and anemia Conclusion At this time no screening programme exists in Trinidad and Tobago Screening will aid in identification and removal of precancerous polyps and cancerous lesions at an early stage which will improve patient survival

Evaluation of a Systematic Method for Risk Stratification and Management of Gastrointestinal Endoscopy Patients

Evaluation of a Systematic Method for Risk Stratification and Management of Gastrointestinal Endoscopy Patients

Development and validation of an algorithm to complete colonoscopy using standard endoscopes in patients with prior incomplete colonoscopy.

Background and study aims Incomplete colonoscopy may occur as a result of colon angulation (adhesions or diverticulosis), endoscope looping, or both. Specialty endoscopes/devices have been shown to successfully complete prior incomplete colonoscopies, but may not be widely available. Radiographic or other image-based evaluations have been shown to be effective but may miss small or flat lesions, and colonoscopy is often still indicated if a large lesion is identified. The purpose of this study was to develop and validate an algorithm to determine the optimum endoscope to ensure completion of the examination in patients with prior incomplete colonoscopy. Patients and methods This was a prospective cohort study of 175 patients with prior incomplete colonoscopy who were referred to a single endoscopist at a single academic medical center over a 3-year period from 2012 through 2015. Colonoscopy outcomes from the initial 50 patients were used to develop an algorithm to determine the optimal standard endoscope and technique to achieve cecal intubation. The algorithm was validated on the subsequent 125 patients. Results The overall repeat colonoscopy success rate using a standard endoscope was 94 %. The initial standard endoscope specified by the algorithm was used and completed the colonoscopy in 90 % of patients. Conclusions This study identifies an effective strategy for completing colonoscopy in patients with prior incomplete examination, using widely available standard endoscopes and an algorithm based on patient characteristics and reasons for prior incomplete colonoscopy.

A novel purgative protocol for capsule endoscopy of the small bowel produces better quality of visibility than 2 l of PEG: Timing is of the essence.

The ideal way of preparing patients for small-bowel capsule endoscopy has been controversial. Previous studies have shown that ingestion of 2 l of polyethylenglycol (PEG) 12 hours prior to capsule ingestion leads to improved visibility in comparison to no preparation at all. We speculated that using a post-ingestion (PI), booster-based cleansing protocol might provide an alternative to the PEG cleansing protocol. This randomized, blinded, prospective study enrolled 45 individuals. Patients were allocated to either of two groups. The PEG group ingested 2 l PEG 12 hours prior to the exam (n = 22) and the PI group ingested one sachet of Picolax® dissolved in 250 ml of water one hour after swallowing the capsule with 500 ml of water (n = 18). Primary endpoints were overall small bowel and distal third of small bowel cleansing levels. Secondary endpoints were average gastric and small-bowel transit time. Forty-five patients participated in this study. Five individuals were excluded because of incomplete study. Percentage of patients with adequate visibility in the distal third of the small bowel in the PEG group was 9% vs 72% in the PI group (p < 0.0001). Average gastric time and total transit time were shorter in the PI group vs the PEG group (p = 0.0065). Timing of ingestion of the Picolax® purgative 60 minutes after swallowing the capsule endoscopy delivers better visibility in the distal third of the small bowel than the accepted cleansing protocol of ingesting 2 l PEG 12 hours prior to the capsule endoscopy procedure.

Parents' Satisfaction with Nursing Care for Pediatric Gastrointestinal Endoscopy Patients in Khartoum State Public Hospitals Khartoum, Sudan

Parents' Satisfaction with Nursing Care for Pediatric Gastrointestinal Endoscopy Patients in Khartoum State Public Hospitals Khartoum, Sudan

Diagnostic and therapeutic endoscopic retrograde cholangiography using a short-type double-balloon endoscope in patients with altered gastrointestinal anatomy : a multicenter prospective study in Japan 1）.

Diagnostic and therapeutic endoscopic retrograde cholangiography using a short-type double-balloon endoscope in patients with altered gastrointestinal anatomy : a multicenter prospective study in Japan^1）.

Pre-Procedural Patient Education Reduces Fall Risk in an Outpatient Endoscopy Suite.

The purpose of this article was to determine whether scripted pre-procedural fall risk patient education and nurses' intention to assist patients after receiving sedation improves receptiveness of nursing assistance during recovery and decreases fall risk in an outpatient endoscopy suite. We prospectively identified high fall risk patients using the following criteria: (1) use of an assistive device, (2) fallen two or more times within the last year, (3) sustained an injury in a fall within a year, (4) age greater than 85 years, or (5) nursing judgment of high fall risk. Using a scripted dialogue, nurses educated high-risk patients of their fall risk and the nurses' intent to assist them to and in the bathroom. Documentation of patient education, script use, and assistance was monitored. Over 24 weeks, 892 endoscopy patients were identified as high fall risk; 790 (88.5%) accepted post-procedural assistance. Documentation of assistance significantly increased from 33% to 100%. Patients receiving education and postprocedural assistance increased from 27.9% to 100% at week 24. No patient falls occurred 12 months following implementation among patients identified as high fall risk. Scripted pre-procedural fall risk education increases patient awareness and receptiveness to assistance and can lead to decreased fall rates.

Patient-Provider Gender Concordance in an Academic Direct Access Endoscopy Practice

Introduction: Patients' preference for gender of their healthcare provider has been well documented across many fields of medicine. Within gastroenterology, several studies have shown a strong preference for gender concordance among women for screening colonoscopy providers, however, less is known about endoscopist gender preference for other indications. This study aims to determine the patientprovider gender concordance of direct access endoscopy patients referred for screening or diagnostic colonoscopy at a large academic institution. While not elicited by scheduling staff, gender preference is accommodated if requested by patient or referring provider. Methods: All colonoscopies performed at the outpatient endoscopy center of the University of Wisconsin Hospital and Clinics during 2014 were evaluated by patient and provider gender. The gender distribution of patients presenting for screening and diagnostic colonoscopies was calculated for each endoscopist. Results: Colonoscopies of 18 endoscopists were reviewed (male = 14, female = 4). Data from 11,361 procedures were included (screening colonoscopies, n= 3185; diagnostic colonoscopies, n= 8196). Of screening colonoscopies, 1670 (52.4%) were performed on females. Of the 581 screening procedures performed by a female endoscopist, 51.4% were done on female patients while 52.6% of the 2604 screening procedures performed by male endoscopists were performed on female patients (p =0.6 ) Of the diagnostic colonoscopies, 4345 (53.0%) were performed on female patients. Female providers performed 775 of 1345 (57.6%) procedures on female patents while male providers performed 3570 of 6851 (52.1%) procedures (p < 0.01). The average percentage of female patients scoped by female providers for diagnostic purposes was 57.6% (SD 2.5) (range 53.8-59.7%) while the average for male providers was 52.1% (SD 2.6) (range 46.6-55.3 %). Conclusion: In our academic endoscopy practice in which patient preference for endoscopist gender is not actively elicited we found no significant difference in the gender distribution of patients undergoing screening colonoscopies between female and male endoscopists. Female providers, however, performed a significantly greater proportion of diagnostic colonoscopies on female patients compared to male endoscopists. Further studies exploring the factors that underlie patient-provider concordance in endoscopy are needed to better align endoscopy providers with patient preferences.

Diagnostic and Therapeutic Endoscopic Retrograde Cholangiography Using a Short-Type Double-Balloon Endoscope in Patients With Altered Gastrointestinal Anatomy: A Multicenter Prospective Study in Japan.

To evaluate the utility and safety of a short-type double-balloon endoscope (DBE) in the treatment of biliary disease in patients with surgically altered gastrointestinal (GI) anatomy. This study was conducted as a multicenter, single-arm, prospective trial at five tertiary academic care centers and three community-based hospitals in Japan. Consecutive patients with biliary disease with altered GI anatomy were prospectively included in this study. A total of 311 patients underwent double-balloon endoscopic retrograde cholangiography (ERC). The success rate of reaching the target site, the primary end point, was 97.7% (95% confidence interval (CI): 95.4-99.1). The success rate of biliary cannulation and contrast injection of the targeted duct, the secondary end point, was 96.4% (95% CI: 93.6-98.2), and the therapeutic success rate was 97.9% (95% CI: 95.4-99.2). Adverse events occurred in 33 patients (10.6%, 95% CI: 7.1-14.0) and were managed conservatively in all patients with the exception of 1 in whom a perforation developed, requiring emergency surgery. ERC using a short-type DBE resulted in an excellent therapeutic success rate and a low rate of adverse events. This treatment can be a first-line treatment for biliary disease in patients with surgically altered GI anatomy.

Predictive overbooking and active recruitment increases uptake of endoscopy appointments among African American patients

Use of GI endoscopy is historically lower in nonwhite ethnic and racial groups compared with whites. These disparities are multifactorial but likely contribute to differences in GI clinical outcomes. We sought to improve endoscopy uptake overall and in minorities by predictive overbooking and active recruitment in a hospital-based GI clinic. From January to October 2014, we alternated between traditional booking for Veterans Affairs Healthcare Network patients with a physician recommendation for endoscopy and active recruitment of patients to fill projected open endoscopy appointment slots. On intervention weeks, patients attending a GI clinic were given the opportunity to "fast track" to an endoscopy appointment on short notice. During control weeks, patients were not actively recruited. We compared uptake of endoscopy appointments in both groups and performed logistic regression to determine predictors of participation in fast-track active recruitment. During fast-track active recruitment for endoscopy, the clinic recruited an additional 111 patients for endoscopy over passive recruitment, including 46 African Americans (41.4%). In a logistic regression model controlling for demographic and clinical characteristics, African Americans were twice as likely (adjusted OR, 1.99; 95% CI, 1.26-3.17) than whites to participate in the fast-track option for recommended endoscopy. Interventions to actively recruit patients for endoscopy increased the overall percentage of GI clinic patients undergoing endoscopy and disproportionately improved endoscopy appointment uptake in African Americans.

Abstract PR003

Background & Objectives: Before the questionnaire-based pre-anesthesia assessment triage system was introduced, all the patients scheduled for endoscopic procedures under MAC were assessed in Pre-anesthesia clinic (PAC) in our hospital. This involved extra time and cost for patients. However, most of these patients were healthy with ASA physical status I-II. In order to improve efficiency while ensuring the safety, we designed the questionnaire-based pre-anesthesia assessment triage system and we performed a perspective study to evaluate. Materials & Methods: We designed a patient filled pre-anesthesia questionnaire form included 14 questions to screen for patients who needed pre-anesthesia assessment in PAC (1)(2). Patients who did not need assessment in PAC would be assessed by anesthetist on the day of procedures. To assess the triage system, we designed an evaluation form printed on the back of the questionnaire form. On the day of scheduled endoscopic procedures, the attending anesthetist assessed the appropriateness of the triage based on questionnaire form and documented it on the form. During Aug 2014 to Oct 2015, we collected and analyzed all the completed questionnaire and evaluation forms. We also collected and analyzed the critical incidents related to MAC endoscopy services during the study period. Results: 4081 patients questionnaire forms were involved in this study. 536 (13.13%) patients were judged to require PAC prior to endoscopic procedures based on the questionnaire form. In the 536 patients, 444 (82.8%) patients were judged to required PAC by the attending anesthetist. 3545(86.87%) patients did not attend PAC based on the questionnaire form. 86 patients from this group were judged to require PAC by the attending anesthetist. In the 86 patients, 61 patients accepted endoscopic as usual without delay after assessed carefully and well prepared. 19 scheduled endoscopy procedures were delayed from 5 mins to 3 hours. Other 6 patients were declined of anesthesia service for endoscopic procedures. 32 patients with undiagnosed hypertension occupied the most in 86 for the reason requried to PAC. 1 critical incident was reported in the MAC endoscopy since triage started and her outcome well. There was no morbidity and mortality related to anesthesia recorded in the 4081 patients. Conclusion: The questionnaire-based pre-anesthesia assessment for endoscopy patients under MAC was safe and efficient.

Indocyanine green retention test (ICG-r15) as a noninvasive predictor of portal hypertension in patients with different severity of cirrhosis.

Portal hypertension is a severe consequence of chronic liver disease, responsible for the main clinical complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) provides important clinical information, but the procedure is invasive and demands expert skills of the staff.In the present study, we aimed to investigate the relationship between the constant infusion indocyanine green (ICG) clearance, the calculated ICG retention test after 15 min (ICG-r15), and HVPG in patients with different severity of cirrhosis for validation of ICG-r15 as a noninvasive predictor of portal hypertension. A total of 325 patients were studied. During a hemodynamic investigation, the ICG clearance was determined using the constant infusion technique and ICG-r15 was calculated. Assessment of the diagnostic performance of ICG clearance and ICG-r15 as predictors of HVPG above 10 mmHg was performed by receiver operating characteristic curve analyses.The ICG clearance and ICG-r15 performed well in all three Child classes, with the most significant results among Child class A patients [area under the receiver operating characteristic (AUROC)=0.832] and less significant results in Child class B (AUROC=0.7448) and Child class C patients (AUROC=0.7392). Only six out of 102 patients in Child class C had HVPG of less than 12 mmHg. ICG-r15 can be used as an indirect assessment of significant portal hypertension in compensated cirrhotic patients. ICG-r15 may be suitable as a screening tool for the identification of patients for endoscopy and measurement of HVPG.Further validation of ICG-r15 together with other predictors of portal hypertension and its clinical use is encouraged.

Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study

ObjectivesTo identify the optimal pharmacological method of preparing patients for nasal endoscopy.Methods Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded.Results The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically.Conclusion Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.

Transglutaminase 2 and Transglutaminase 2 Autoantibodies in Celiac Disease: a Review.

Celiac disease is a common inflammatory disorder with a prevalence of 1-2% in which a distinct dietary wheat, rye, and barley component, gluten, induces small-bowel mucosal villous atrophy, crypt hyperplasia, and inflammation. The small-bowel mucosal damage can be reversed by a strict lifelong gluten-free diet, which is currently the only effective treatment for the condition. A key player in the pathogenetic process leading to the enteropathy is played by a protein called transglutaminase 2 (TG2), which is able to enzymatically modify gluten-derived gliadin peptides. The TG2-catalyzed deamidation of the gliadin peptides results in their increased binding affinity to the disease-predisposing human leukocyte antigen (HLA) DQ2 and DQ8 molecules, thus enabling a strong immune response to be launched. Blocking the enzymatic activity of TG2 has thus been suggested as a suitable novel pharmacological approach to treat celiac disease. By virtue of its transamidation capacity, TG2 is also able to cross-link gliadin peptides to itself, this resulting in the generation of TG2-gliadin peptide complexes whose presence might provide an explanation for the generation of the TG2 autoantibodies characteristic of celiac disease. Due to their excellent specificity for the disorder, the TG2-targeted autoantibodies are widely used in the diagnostics as a first-line test to select patients for gastrointestinal endoscopy. More recently, it has come to be appreciated that these autoantibodies and also the TG2-specific B cells might play an active role in the disease pathogenesis. In this review, we assess the role of TG2, TG2-specific B cells, and autoantibodies in celiac disease.

PTU-037 Endoscopy in the Centenarians: Is it Worth the Trouble?

Introduction Gastrointestinal Endoscopy in the very elderly is generally considered risk prone and there is a degree of reluctance to perform procedures in this age group. Centenarians are people who live to or beyond 100 years of age. According to the Office of National Statistics, in 2014 there were 14,450 centenarians living in the U.K, having risen by 72% over the last decade. 1 It is estimated that the number of people over the age of 100 years will approximately double by 2020. 2 Little is known about digestive endoscopy in the centenarians. This retrospective study aimed to explore endoscopic practice in this group of patients. Methods A retrospective study was undertaken, analysing endoscopic practice in the centenarians in a University Hospital over a period of ten years (01/01/2005 to 01/01/2015). Endoscopy reports were retrieved using the Hospital’s Endoscopy Reporting tool (Unisoft) and patients’ Date of birth and demographic details were confirmed using the Trust’s patient database. Results A total of 11 procedures (7 Gastroscopies, 3 sigmoidoscopies and 1 Colonoscopy) were undertaken in 10 patients (4 male and 6 female). Oldest patient was 119 years of age and the youngest 101 years. Mean age was 105.2 years. 7 patients were Caucasians, 2 Indian and 1 Afro Caribbean of ethnicity. 72% of the procedures were undertaken on an urgent basis. 70% of patients were inpatients and majority of the procedures were undertaken by Consultants (82%). Indications included Dysphagia (36.3%), Melena (27.2%), Rectal Bleeding (27.2%) and previous Cancer (9%). The procedural yield was high (81.8%) with endoscopic intervention undertaken in 2 cases (Duodenal ulcer bleeding which was treated with adrenaline injections and haemorrhoids which were banded). Only 2 of the procedures (18%) were undertaken under sedation (midazolam). All procedures were completed and no immediate complications were noted. Conclusion To the best of the authors’ knowledge this is the only study analysing endoscopic practice in the centenarians. While we acknowledge that sample size is small it demonstrates that endoscopic procedures can be performed safely and that the diagnostic yield is high. Majority of the patients tend to be inpatients and undergo the procedure on an urgent basis by consultants.A patients’ age should not be the sole factor when deciding suitability for endoscopic procedures, bearing in mind the increasing number of centenarians requiring this service. Larger studies are required to gain a better understanding of endoscopic suitability for patients in this age group. References 1 http://www.ons.gov.uk/ons/dcp171778_418037.pdf 2 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/223229/Centenarians.pdf Disclosure of Interest None Declared