Flexible Endoscopy Research Articles

Assessment of early paediatric airway sequelae after using cuffed or uncuffed endotracheal tubes with ultrasound and flexible endoscopy

ABSTRACT Background Cuffed tracheal tubes (CTT) emerge to prevent air leakage despite that most anaesthesiologists prefer the uncuffed tracheal tubes (UTT) in the paediatrics. Using recent tools for evaluation of endotracheal intubation sequelae may help to prevent airway injury and determine the appropriate type and size of endotracheal tube (ETT). Purpose The study aimed to detect the early airway changes after using CTT or UTT in paediatrics. Also, to find out the correlation between the endoscopic and ultrasonographic findings in detection of post intubation sequelae in paediatrics. Methods A prospective, randomized study was performed over 80 children aged from two to five years, scheduled for abdominal surgeries under the effect of general anaesthesia. Patients were assigned into two equal groups: Group C: CTT and Group U: UTT. Results There was less statistically significant ETT exchange in the group C (p = 0.020). No significant difference could be found as regard to the change in the subglottic diameter, the incidence of stridor, laryngospasm and croup, and the occurrence of airway injuries. There was a positive correlation between the change in the subglottic diameter and the prevalence of airway injuries (P = 0.014). The duration of the endotracheal intubation could not influence the incidence of neither the stridor nor the airway injuries in both groups. Conclusion There were no difference between the use of CTT or UTT in the paediatrics in terms of early airway changes. However, the rate of tube exchange is significantly lower when using CTT. A positive correlation is found between the endoscopic and ultrasound findings in the detection of post intubation sequelae in paediatrics. Short-term endotracheal intubation neither affects the incidence nor the severity of airway injuries. Using the external diameter of the endotracheal tube instead of the inner diameter is crucial for proper sizing in paediatrics.

Histopathology of Endoscopic Biopsies of Gastrointestinal Tract Lesions with Clinical Correlation

Introduction: Because of limited anatomical space and certain unusual clinicopathological features, gastrointestinal tract lesions causes problem in their diagnosis, prognosis, and management. The primary objective of the study is to know the utility of endoscopic biopsy in diagnosing gastrointestinal lesions, and the secondary objective is to correlate the histopathological findings with the clinical symptoms and endoscopic appearance of the lesions. Materials and Methods: The present study is a simple retrospective observational study. Upper and lower gastrointestinal lesions in the form of ulcer, polyp, and growth were biopsied by biopsy forceps using flexible fiberoptic endoscopes. Only adequate biopsies were included in the study. The exact site of the biopsy with clinical data was provided by the endoscopist. Routine histopathological examination was done on the specimens submitted in 10% formalin. The use of special stains was done wherever needed. Results: A total of 100 cases were categorized as nonneoplastic and neoplastic. Friedman and Osborn classification was used for nonneoplastic lesions. The maximum number of cases was seen in 5th–6th decade with male predominance with equal distribution of cases as far as anatomical site is concerned. Conclusion: Targeted biopsies are possible with definitive diagnosis in 90% of cases with safe use of endoscopy. 17% of cases diagnosed on endoscopy were confirmed on histopathology. In 73% of cases, histopathology was essential for further subtyping. Histopathology was mandatory in 8% of the cases. Recommended combined use of endoscopy and histopathology can offer a definitive diagnosis in 98% of cases.

Tracing High-Level Disinfection in Physician Practices to Improve Safety with Single-Use Disposable Flexible Endoscopes

Tracing High-Level Disinfection in Physician Practices to Improve Safety with Single-Use Disposable Flexible Endoscopes

Management of the Zenker diverticulum: multicenter retrospective comparative study of open surgery and rigid endoscopy versus flexible endoscopy.

Zenker's diverticulum is a rare disease that affects quality of life due to dysphagia and regurgitation. This condition can be treated by various surgical or endoscopic methods. Patients treated for Zenker's diverticulum in three centers in the south of France between 2014 and 2019 were included. The primary objective was clinical efficacy. Secondary objectives were technical success, morbidities, recurrences, and need for a new procedure. One hundred forty-four patients with a total of one hundred sixty-five procedures performed were included. A significant difference was found between the different groups in terms of clinical success (97% for open surgery versus 79% for rigid endoscopy versus 90% for flexible endoscopy, p = 0.009). Technical failure occurred more frequently in the rigid endoscopy group than in the flexible endoscopy and surgical groups (p = 0.014). Median procedure duration, median time to resumption of feeding, and hospital discharge were statistically shorter for endoscopies than for open surgery. On the other hand, more recurrences occurred in patients treated by endoscopy than those treated by surgery, and more reinterventions were required. Flexible endoscopy appears to be as effective and safe as open surgery in the treatment of Zenker's diverticulum. Endoscopy allows a shorter hospital stay at the expense of a higher risk of recurrence of symptoms. It could be used as an alternative to open surgery for the treatment of Zenker's diverticulum, especially in frail patients.

Usefulness of a newly developed endoscope for the observation of the posterior tracheal wall.

Videoendoscopic evaluation of swallowing is an objective swallowing function evaluation method used in dysphagia rehabilitation. However, it is anatomically difficult to detect the entry of foreign substances through the posterior tracheal wall using a conventional endoscope (CE). In this study, we developed an endoscope that can observe the posterior tracheal wall and investigated its reliability and validity in healthy adults. Twenty healthy adults were included. The trachea was observed from inside the larynx using a CE and a portable, flexible two-step angulation endoscope (two-AE) with a two-step curved shaft tip. The visibility of the anterior and posterior walls was recorded. The time from the endoscope tip entering the larynx to the posterior tracheal wall was measured. Additionally, discomfort events were assessed after the examination. McNemar's test and a paired t-test were used for statistical analysis. Kappa coefficients and concordance rates were calculated. The anterior tracheal wall was observed using both endoscopes. The posterior tracheal wall was significantly observed in 18 participants with the two-AE (p < .001), compared to only three of 20 participants with the CE. The time to observation of the posterior tracheal wall for examiners 1 and 2 was 13.3 ± 6.5 and 12.0 ± 6.7 s, respectively, with no difference between groups (p = .400). The kappa coefficients of examiners 1 and 2 and between the examiners were 0.444, 0.643, and 0.643, respectively, with concordance rates of 90%, 95%, and 95%, respectively. Regardless of the examiner's years of experience, we observed that the two-AE could observe the posterior tracheal wall. Step 5.

Flexible robotic endoscopy for treating gastrointestinal neoplasms.

Therapeutic flexible endoscopic robotic systems have been developed primarily as a platform for endoscopic submucosal dissection (ESD) in the treatment of early-stage gastrointestinal cancer. Since ESD can only be performed by highly skilled endoscopists, the goal is to lower the technical hurdles to ESD by introducing a robot. In some cases, such robots have already been used clinically, but they are still in the research and development stage. This paper outlined the current status of development, including a system by the author's group, and discussed future challenges.

Laser ablation of the equine oviductal papilla as a novel contraceptive technique

Reproductive control of wild horses has frustrated land management groups for decades. GnRH and Zona Pellucida vaccines have a limited duration of efficacy, intrauterine devices are unpredictably retained, and attempts to ovariectomize mares in the western United States were met with public outcry in 2018. The development of a non-surgical permanent sterilization technique has the potential to revolutionize management of wild equids on public lands. The objectives of this study were to develop a safe and effective sterilization technique for reproductively healthy mares. We hypothesized that laser ablation of the oviductal papillae would be an effective method of permanent sterilization. Seven light-breed reproductively healthy mares (5-21yrs) were enrolled in the study. On enrollment, mares were sedated for hysteroscopy, and the endometrium and oviductal papillae were examined using a 103cm flexible endoscope (Olympus GIF-160 Gastroscope, Center Valley, PA) attached to an Olympus EVIS EXERA CV-160 video processor. In five mares, a 600 μm laser fiber was advanced through the biopsy channel and a diode laser (Dornier Medilas D, Dornier MedTech America, Inc., Kenneasaw, GA) was used to deliver direct contact pulses of 3 to 5 seconds in duration to the oviductal papilla. The endoscope was then guided up the contralateral horn and the process repeated. In two control mares, the oviductalpapillae were visualized, but no laser ablation was performed. All mares received 5 mg dinoprost IM and a uterine lavage within 4 hours post-procedure. Transrectal ultrasound was performed every 2-3 days until a 35mm follicle was detected, and then mares were bred using semen from a fertile stallion. Pregnancy status was determined by transrectal ultrasound 14 days post-ovulation, luteolysis was induced, and mares were rebred on 2-4 consecutive cycles. Control mares conceived on 6 out of 9 cycles (67% pregnancy rate). Pregnancy rate was significantly lower in the treatment group (5%, 1 out of 20 cycles, p=0.003). The first mare that was laser ablated conceived on the 4th cycle, and repeat hysteroscopy determined that the left oviduct was not effectively ablated. The third mare was diagnosed with peritonitis via abdominocentesis 6 hours post hysteroscopy. The mare was treated with broad spectrum antibiotics and recovered uneventfully. Three mares were re-bred two years after the procedure and did not conceive. In conclusion, when laser ablation of the oviductal papillae was appropriately performed, scar tissue formation effectively prevented pregnancy for a minimum of four months post-procedure. Laser ablation of the oviductal papillae is a promising technique for permanent sterilization of the mare and a follow-up long-term fertility study is warranted in a larger group of mares is warranted.

A Novel Distal Hybrid Pneumatic/Cable‐Driven Continuum Joint with Variable Stiffness Capacity for Flexible Gastrointestinal Endoscopy

A Novel Distal Hybrid Pneumatic/Cable‐Driven Continuum Joint with Variable Stiffness Capacity for Flexible Gastrointestinal Endoscopy

Adult corrosive ingestions in the Pietermaritzburg Metropolitan Surgical Service.

There is a paucity of data around corrosive ingestion in South Africa over the last three decades. As such, we set out to review our experience with adult corrosive ingestion in our tertiary gastrointestinal surgical service. A retrospective, quantitative review was performed. The parameters analysed were demographics, substance ingestion, ingestion time to first presentation to a healthcare facility, clinical presentation, severity of injury based on endoscopic classification, computed tomography (CT) findings, management and outcomes. Patients presenting within 72 hours with alarm symptoms underwent flexible upper endoscopy and injury severity grading. In patients presenting after 72 hours, a water-soluble contrast study was obtained prior to upper endoscopy. Patients with signs of sepsis, surgical emphysema or physiological instability were referred for urgent CT to exclude oesophageal perforation and mediastinitis. Between January 2012 and January 2019, a total of 64 patients presented with a history of corrosive ingestion - 40 (31%) were males and 24 (19%) females. The average time from ingestion to presentation was 72 hours. In 78% of patients, the agents were intentionally ingested, whilst 22% claimed accidental ingestion. A quarter of the patients (21%) presented to the unit clinically unstable, requiring emergent cardiorespiratory support. Eight (12%) patients required urgent surgical intervention due to the extent of injury. Nine (14%) patients demised during the acute admission. Of this group, three patients had undergone surgical intervention, and six were managed conservatively. Eighty-five per cent of all patients survived their initial admission. This paper has highlighted the problem of corrosive ingestion in our setting. It remains a complicated problem to manage associated with significant morbidity and mortality rates. The current trend in the assessment of these patients is increased use of CT scan to assess the extent of transmural necrosis. Our algorithms should change to reflect this contemporary approach.

Point-of-care isoenzyme type M2 pyruvate kinase quick stool test for the detection of gastric cancer in Rwanda: A pilot study.

e18530 Background: Isoenzyme type M2 pyruvate kinase (M2-PK) can only be detected in gastrointestinal (GI) tumors. Detection of M2-PK on a small, portable platform with minimal training required, could offer a streamlined approach for the diagnosis of GI cancers especially in low-income countries (LIC's). We evaluated the feasibility of M2-PK stool test to detect gastric cancer in Rwanda. Methods: Participants with GI symptoms were screened and scheduled for upper endoscopy during the 5th Annual Rwanda Endoscopy Week. Participants who underwent gastric biopsy and provided a stool sample were enrolled. Three Rwandan medical centers participated. ScheBo M2-PK Quick test (Biotech AG, Giessen, Germany) was used to test fecal tumor M2-PK. Study approval was obtained from Dartmouth Health, UConn Health, and University of Rwanda IRB's. Descriptive statistics were estimated. Study is currently enrolling patients to reach the desired sample size (N = 110). Results: A total of 35 patients were consented; 26 patients did not have a biopsy, 1 did not provide a stool sample, 1 was lost to follow-up, and 7 were analyzable. 57.1% were male (n = 4) and 42.9% females (n = 3) with ages ranging from 50 to 71 years old. Males accounted for 66.6% of the cases of gastric cancer (n = 2). The most predominant symptoms reported were dyspepsia (66.7%), and weight loss (33.3%). Among those with hemoglobin levels available the mean was 8.63 g/dL (SD ± 0.71). Only one patient completed staging imaging with CT scans. Two patients with positive M2-PK stool tests had a proven diagnosis of gastric cancer (100%). One of them had a diagnosis of GIST. There was only 1 confirmed gastric adenocarcinoma in 5 patients with a negative M2-PK stool test, yet two patients were told to repeat the endoscopy procedure. Conclusions: A point-of-care (POC) quick stool test to screen gastric cancer is feasible in Rwanda. Study participation interest was high among Rwandan patients. Due to a lack of flexible endoscopes in LIC's, screening is restricted to patients living near regional or urban endoscopy centers, which contributes to the growing prevalence of gastric cancer and health disparities. Cancer control programs in LIC's can be implemented and maintained iteratively with realistic expectations and interventions tailored to the local population, its cultural values, and economic infrastructure. Thus, an emerging POC M2-PK stool test can triage patients to early medical attention when suspected gastric cancer.

Multiportal Retrograde Endoscopy to Enhance Surgical Target Visualization: A Pilot Study.

Objective Current transnasal endoscopic techniques for sinus and skull base surgery use a single endoscope to provide visualization from one perspective curtailing depth perception and compromising visualization of the instrument-target interface. The view can be blocked by instruments, and collisions between instruments often occur. The objective of this study was to investigate the use of multiportal retrograde endoscopy to provide more accurate manipulation of the surgical target. Design Maxillary antrostomy and frontal sinusotomy were performed on three different cadavers by three different surgeons. A zero-degree rigid endoscope was introduced through the nose for the standard transnasal approach. A flexible endoscope was introduced transorally, directed past the palate superiorly, and then flexed 180 degrees for the retrograde view. Videos of the standard transnasal view from the rigid endoscope and retrograde view from the flexible endoscope were recorded simultaneously. Results All surgeries were able to be performed with dual-screen viewing of the standard and retrograde view. The surgeons noted that they utilized the retrograde view to adjust the location of ends/tips of their instruments. Four surgeons reviewed the videos and individually agreed that the visualization achieved provided a perspective otherwise not attainable with rigid transnasal endoscopy alone. Conclusion High-quality visualization of surgical targets such as the frontal or maxillary ostia can be challenging with rigid endoscopes alone. Multiportal retrograde endoscopy provides proof of concept that additional views of a surgical target can be achieved. Additional work is needed to further develop indications, techniques, and generalizability to targets beyond those investigated here.

Nearest and ling-time outcomes of endoscopic treatment of patients with esophageal achalasia

The purpose of the study is analyze of the results of peroral endoscopic myotomy in patients with esophageal achalasia. Material and methods. In the period 2017-2022 years peroral endoscopic myotomy in esophageal achalasia was performed in 110 patients (43 - men, 77 - women). Mean aged from 7 to 75 years. The duration of the disease ranged from 6 months to 40 years. Results. In 109 cases, the intervention was technically successful. The intervention was not successful due to the severity of fibrosis in the submucosal layer in 1 patient. The operation time ranged from 45 to 195 minutes. Complications during the intervention were in 9 (8,18%) patients. In the postoperative period, in 4 (3,63%) patients had complications that were eliminated by using flexible endoscopes. Patients were discharged from the hospital 3-5 days after the operation. There were not re-interventions performed. Erosive reflux esophagitis is the most common condition in the postoperative period. This condition was successfully stopped by inhibitors proton pump taking. When examining in the postoperative period and assessing the level quality of life using questionnaires SF-36, GIQLI and the Eckardt scale noted relief of dysphagia and a significant improvement in the main indicators. Conclusion. Peroral endoscopic myotomy in patients with esophageal achalasia can be the operation of choice in terms of efficiency, safety and long-term results, the level of quality of life in the postoperative period. To assess the long-term results of the intervention in this category of patients, further monitoring is required.

Transanal formation of anastomosis using C-REX device is feasible and effective in high anterior resection

PurposeC-REX is a novel instrument for creating stapleless colorectal anastomosis by compression. The aim of this study was to evaluate the feasibility and effectiveness of C-REX in open and laparoscopic high anterior resections.MethodsA prospective clinical safety study on 21 patients reconstructed with C-REX colorectal anastomosis following high anterior resection of the sigmoid colon using two different devices for intraabdominal (n = 6) or transanal (n = 15) placement of the anastomotic rings. Any signs of complications were prospectively monitored by a predefined protocol. Anastomotic contact pressure (ACP) was measured via a catheter-based system, and time for evacuation of the anastomotic rings by the natural route was noted. Blood samples were collected daily, and flexible endoscopy was performed postoperatively to examine macroscopic appearance of the anastomoses.ResultsOne of six patients operated with the intraabdominal anastomosis technique with an ACP of 50 mBar had to be reoperated because of anastomotic leakage. None of the 15 patients operated with the transanal technique (5 open and 10 laparoscopic procedures) had anastomotic complications, and their ACP ranged between 145 and 300 mBar. C-REX rings were uneventfully expelled by the natural route in all patients after a median of 10 days. Flexible endoscopy showed well-healed anastomoses without stenosis in 17 patients and a moderate subclinical stricture in one patient.ConclusionThese results indicate that the novel transanal C-REX device is a feasible and effective method for colorectal anastomosis following high anterior resections, irrespective of open or laparoscopic approach. Moreover, C-REX allows measurement of intraoperative ACP and thereby a quantitative evaluation of the anastomotic integrity.

Iron‐deficiency anaemia and severe hypocobalaminaemia and hypofolataemia in a dog fed a homemade diet

AbstractA middle‐aged, female, neutered dog was diagnosed with iron‐deficient anaemia on a routine health check following rescue from a puppy mill. Further investigations revealed a severe hypocobalaminaemia and hypofolataemia. The dog was fed a homemade diet consisting of various types of human food and it had been used for breeding. Pale mucous membranes and mild lethargy were noted on the initial presentation. No ulcerations of the gastrointestinal tract were seen on flexible endoscopy, but lymphocytic and eosinophilic inflammation, indicative of chronic inflammatory enteropathy, was present on histopathology. The dog had no vomiting or diarrhoea and there was no macro‐ or microscopic gastrointestinal bleeding. The condition resolved after providing a commercial, balanced diet and supplementing iron, cobalamin and folate orally. This case report describes the clinical investigation of a dog with iron deficiency, hypocobalaminaemia and hypofolataemia, where malnutrition and excessive breeding may have contributed to this condition.

Hysteresis Modeling and Compensation for Tendon-Sheath Mechanisms in Robot-Assisted Endoscopic Surgery Based on the Modified Bouc-Wen Model With Decoupled Model Parameters

The tendon-sheath mechanism (TSM) has been widely applied in flexible endoscopy (FE) and natural orifice transluminal endoscopic surgery (NOTES) owing to its advantages of remote force and displacement transmission, size reduction, compactness, and convenient implementation. However, the positioning accuracy of TSMs is highly restrained by the motion hysteresis due to the complex friction condition between the tendon and sheath. The hysteresis phenomenon has posed significant challenges for modeling and controlling TSMs. This paper proposes a modified Bouc-Wen-based mathematical model to characterize the asymmetric hysteresis loop with distinct inflection points. The model parameters are decoupled, facilitating identification and reducing computational costs. Moreover, the model has retained the Bouc-Wen model structure, allowing for efficient derivation of the feedforward compensator based on the inverse multiplicative structure. The compensator was derived and cascaded with the TSM system to suppress the hysteresis phenomenon. Totally 120 trials of experiments were conducted to validate the proposed model and the feedforward control scheme on the two TSMs with different accumulated curvatures of 180∘ and 360∘. The results indicated that the proposed method achieved a 25.5% and 43.9% lower estimation and compensation error than the classical Bouc-Wen model. Further, it is worth noting that the model parameter identification time consumption has been significantly reduced to 5.8ms. The proposed model and the feedforward compensator can effectively linearize the TSM system and further facilitate delicate operations in robot-assisted surgical procedures.

Innovation in rigid bronchoscopy-past, present, and future.

German laryngologist Gustav Killian performed the first "Direkte Bronchoskopie" using a rigid bronchoscope to extract a foreign airway body from the right main bronchus over a hundred years ago, transforming the practice of respiratory medicine. The procedure instantaneously became popular throughout the world. Chevalier Jackson Sr from the United States further advanced the instrument, technique, safety, and application. In the 1960s, Professors Harold H. Hopkins and N.S. Kapany introduced optical rods as well as fiberoptics that led Karl Storz to develop the cold light system improving endoluminal illumination, achievements that ushered in the modern era of flexible endoscopy. Several diagnostic and therapeutic procedures became possible such as transbronchial needle biopsy, transbronchial lung biopsy, airway electrosurgery, or cryotherapy. Dr. Jean-François Dumon from France advanced the use of Nd-YAG laser in the endobronchial tree and created the dedicated Dumon silicone stent introducing the whole new field of interventional pulmonology (IP). This major milestone revitalized interest in rigid bronchoscopy (RB). Now, advancements are being made in stenting, instrumentation, and education. RB robotic technology advancements are currently anticipated and can potentially revolutionize the practice of pulmonary medicine. In this review, we describe some of the most substantial advances related to RB from its beginning to the modern era.

Coupling optimized bending-insensitive multi-core fibers for lensless endoscopy.

We report a bending-insensitive multi-core fiber (MCF) for lensless endoscopy imaging with modified fiber geometry that enables optimal light coupling in and out of the individual cores. In a previously reported bending insensitive MCF (twisted MCF), the cores are twisted along the length of the MCF allowing for the development of flexible thin imaging endoscopes with potential applications in dynamic and freely moving experiments. However, for such twisted MCFs the cores are seen to have an optimum coupling angle which is proportional to their radial distance from the center of the MCF. This brings coupling complexity and potentially degrades the endoscope imaging capabilities. In this study, we demonstrate that by introducing a small section (1 cm) at two ends of the MCF, where all the cores are straight and parallel to the optical axis one can rectify the above coupling and output light issues of the twisted MCF, enabling the development of bend-insensitive lensless endoscopes.

The utility of intraoperative endoscopy in esophagogastric surgery

Flexible endoscopy (FE) plays a major role in the diagnosis and treatment of gastrointestinal disease. Although its intraoperative use has spread over the years, its use by surgeons is still limited in our setting. FE training opportunities are different among many institutions, specialties, and countries.Intraoperative endoscopy (IOE) presents peculiarities that increase its complexity compared to standard FE. IOE has a positive impact on surgical results, due to increased safety and quality, as well as a reduction in the complications. Due to its innumerable advantages, its intraoperative use by surgeons is currently a current project in many countries and is part of the near future in others because of the creation of better structured training projects.This manuscript reviews and updates the indications and uses of intraoperative upper gastrointestinal endoscopy in esophagogastric surgery.

Prospective Analysis of Versatility and User Satisfaction with a Novel Single-Use Cystoscope with Working Channel

Introduction: In the present study, a prospective systematic assessment of the clinical utility of the Ambu^® aScopeTM 4 Cysto Reverse Deflection with regard to image quality, maneuverability, and navigation in an outpatient and inpatient setting was performed. Materials and Methods: A prospective multicenter study was performed for evaluation of the instrument during routine cystoscopy. We evaluated the clinical performance of the instruments using a standardized user questionnaire in different categories including image quality, treatment success, imaging of all areas of the urinary bladder, quality of navigation, flexibility of the endoscope, and satisfaction with the device. Statistical analyses were performed by SPSS using the Kruskal-Wallis and Wilcoxon-Mann-Whitney tests. A p value of p ≤ 0.05 was defined as statistically significant. Results: A total of 200 cystoscopies were performed, and the questionnaire response rate was 100%. The image quality was rated as very good in 65.5% (n = 131), good in 30.5% (n = 61), and neutral in 4% (n = 8) of cases. The criteria for poor or very poor were not mentioned. The characteristic “treatment success based on image quality” was also evaluated as very good in 49% (n = 98) and good in 50.5% (n = 101). The analysis revealed a very good or good overall impression of the examiners in all cases. Replacement of the cystoscope was not necessary during any of the examinations. However, in 3 cases, technical difficulties were documented. Further analysis of the data showed that physicians with less professional experience rated the visualization of the urinary bladder (p = 0.007) and the treatment success with regard to image quality significantly worse (p = 0.007). Conclusion: The Ambu^® aScope™ 4 Cysto Reverse Deflection shows high satisfaction values among users in clinical routine. In analogy to other studies with flexible endoscopes, urologists with more professional experience show higher satisfaction values than examiners with less training in flexible endoscopy.

Preference matters: New aspects on how foreign bodies should and could be removed from a child's airway.

Foreign body aspiration in children is a potentially life-threatening event that can be diagnosed and treated by airway endoscopy. We aimed to analyze the influence of the examiner's experience and preference on the choice of the technique and the resulting complication rate. In this international study, experts in the field documented their preferred and applied technique as well as the outcome of each case of foreign body removal. Personal data of the bronchoscopists and their medical center were collected via an online questionnaire separately from the case specifics. A total of 399 foreign body removals were performed by 64 examiners. A total of 279 removals were performed using rigid endoscopy, and 120 procedures were performed by flexible. When a difficulty was expected, flexible endoscopy was used significantly more often (χ2 (1) = 11.06, p < 0.001). Complications occurred significantly less often when the bronchoscopist used their preferred technique (χ2 (1) = 6.41, p = 0.011), had more than 5 years of experience (χ2 (1) = 5.13, p = 0.023) or performed more than 100 removals (χ2 (2) = 11.51, p = 0.003). In medical centers, complication rates significantly decreased if more than 200 bronchoscopies were performed in children, compared to the centers that perform 50-200 bronchoscopies per year (χ2 (1) = 24.56, p < 0.001). Preference and experience of a bronchoscopist and his/her medical center with flexible or rigid foreign body removal distinctively affect the outcome of the procedure and cannot be neglected in the discourse on the appropriate technique. This link also emphasizes the importance of a structured training program.