Practice Of Gastrointestinal Endoscopy Research Articles

Ethnic variations in ulcerative colitis: Experience of an international hospital in Thailand.

To investigate the clinical characteristics, treatment, medication use, and treatment response in patients with ulcerative colitis (UC) across ethnic groups. This study retrospectively analyzed medical records of all 268465 patients who visited the Bumrungrad International Digestive Disease Center during 2005-2010. The demographics, clinical characteristics, medication use, results of investigations, and medical and surgical management for patients with UC were evaluated. Evaluation included sigmoidoscopy and colonoscopy performed in compliance with the American Society of Gastrointestinal Endoscopy practice guidelines. Patient ethnicities were categorized into seven groups: Thai, Oriental, South Asian (SA), Middle Eastern (ME), Caucasian, African, and Hispanic. UC pathological severity was classified into inactive, mild, moderate, and severe. Associations between categorical variables were analyzed using the χ(2) or Fischer's exact test. Associations between categorical and interval variables were analyzed using Student's t-test and/or analysis of covariance. UC was diagnosed in 371 of the 268465 patients: male 56.33%; ME 42%, Caucasian 23%, and Thai 19%. Annual incidence of UC was 82 cases per 100000 with wide ethnic variation, ranging from 29 to 206 cases per 100000 in Oriental and ME patients, respectively. Of the patients with UC, 16.71% had severe UC with highest incidence among the patients from ME (20.39%) and lowest among the Caucasian population (11.90%). ME had highest proportion of pancolitis (52.90%), followed by Caucasian (45.35%) and Asian (34.40%). Only 20.93% of Caucasian patients received steroid, compared with 26.40% and 27.10% of Asian and Middle Eastern, respectively (P = 0.732). Overall, 13.72% of UC patients did not respond to steroid therapy, with non-significantly higher proportions of non-responders among Asian and Middle Eastern patients (15.22% and 15.04%, respectively) (P = 0.781). On average, 5.93% underwent surgical management with ethnic variation, ranging from 0% in African to 18% in SA. Cancer was found in three (Thai, ME, and African) cases (0.82 institution-specific incidence). Incidence, symptom duration, pathological severity, clinical manifestations, medication use, treatment response, need for surgical consultation, and cancer incidence of patients with UC potentially vary by ethnicity.

Continuation or discontinuation of antithrombotics in clinical daily practice of gastrointestinal endoscopy: Has a paradigm shift occurred in Japan?

Continuation or discontinuation of antithrombotics in clinical daily practice of gastrointestinal endoscopy: <scp>H</scp>as a paradigm shift occurred in <scp>J</scp>apan?

When to do paediatric gastrointestinal endoscopy?

Abstract Over the last few decades, paediatric gastroenterology has rapidly developed into a well-established sub-specialty. Improvements in training and equipment have led to enhanced safety with fewer complications following endoscopies. In specialized units, diagnostic and therapeutic upper gastrointestinal endoscopy and proctosigmoidoscopy/colonoscopy are regularly performed under conscious sedation or general anaesthesia. Emerging guidelines and new advances in the diagnostic tools are being incorporated into routine paediatric gastrointestinal endoscopy practice.

Self-expanding metallic stents and self-expanding plastic stents in the palliation of malignant oesophageal dysphagia.

Endoluminal stenting has revolutionised the practice of gastrointestinal endoscopy for many years. What started as rigid, inflexible, plastic stents have now evolved into flexible, easy-to-deploy self-expanding stents with a myriad of choices, including covered, partially covered and uncovered types. Many of these also come along with special features including anti-reflux, anti-migration and lasso for stent adjustment and retrieval. Numerous papers with meta-analyses and systemic reviews have without doubt confirmed the efficacy, safety and cost effectiveness of endoluminal stenting in the palliation of malignant obstruction of the oesophagus, stomach, duodenum, colon and the biliary tree. This paper will focus on the use of self-expanding plastic stents (SEPS) as well as self-expanding metallic stents (SEMS) in the palliation of malignant oesophageal obstruction.

Fundamentals of Endoscopic Surgery cognitive examination: development and validity evidence

Flexible endoscopy is an integral part of surgical care. Exposure to endoscopic procedures varies greatly in surgical training. The Society of American Gastrointestinal and Endoscopic Surgeons has developed the Fundamentals of Endoscopic Surgery (FES), which serves to teach and assess the fundamental knowledge and skills required to practice flexible endoscopy of the gastrointestinal tract. This report describes the validity evidence in the development of the FES cognitive examination. Core areas in the practice of gastrointestinal endoscopy were identified through facilitated expert focus groups to establish validity evidence for the test content. Test items then were developed based on the content areas. Prospective enrollment of participants at various levels of training and experience was used for beta testing. Two FES cognitive test versions then were developed based on beta testing data. The Angoff and contrasting group methods were used to determine the passing score. Validity evidence was established through correlation of experience level with examination score. A total of 220 test items were developed in accordance with the defined test blueprint and formulated into two versions of 120 questions each. The versions were administered randomly to 363 participants. The correlation between test scores and training level was high (r = 0.69), with similar results noted for contrasting groups based on endoscopic rotation and endoscopic procedural experience. Items then were selected for two test forms of 75 items each, and a passing score was established. The FES cognitive examination is the first test with validity evidence to assess the basic knowledge needed to perform flexible endoscopy. Combined with the hands-on skills examination, this assessment tool is a key component for FES certification.

Molecular imaging in gastroenterology

Molecular imaging is a novel field in gastroenterology that uses fluorescently labelled probes to specifically highlight neoplastic lesions on the basis of their molecular signature. The development of molecular imaging has been driven by the need to improve endoscopic diagnosis and by progress in targeted therapies in gastrointestinal oncology to provide individualized treatment, which coincides with progress in endoscopy techniques and further miniaturization of detection devices. Different exogenous molecular probes for imaging include labelled antibodies, oligopeptides, affibodies(™) (Affibody AB, Bromma, Sweden), aptamers and activatable probes. Molecular imaging has been evaluated in two major indications: many trials have studied molecular imaging as a red flag technique to improve detection of lesions in wide-field imaging; on the other hand, microscopic analysis has been investigated for in vivo characterization of the molecular fingerprint of tumours with the ultimate goal of assessing the likelihood of response to targeted therapy. This Review focusses on the applications of molecular imaging that have immediate potential for translational science or imminent transition into clinical practice of gastrointestinal endoscopy.

Unsedated small caliber esophagogastroduodenoscopy: Can we trust this technique?

Small caliber endoscopes are one of the best examples of fantastic technological advancements in gastrointestinal endoscopy. First designed for pediatric patients in the 1970s, current small caliber videoendoscopes were used for unsedated transnasal gastrointestinal endoscopy after 1994. Nowadays, unsedated endoscopy can be successfully done using small caliber endoscopes via transoral or transnasal route in nearly 90% of cases. Several large studies have shown that small caliber endoscopy is feasible, safe and well-tolerated. These devices can decrease the potential risks of upper gastrointestinal endoscopy by eliminating the need for sedation since these ultrathin endoscopes induce much less gag reflex or choking sensation in patients. Moreover, gastrointestinal endoscopy with small caliber endoscopes results in less sympathetic system activation as well as less oxygen desaturation compared to standard endoscopy, especially in aged, severely ill, bedridden patients. Nevertheless, there is no overall consensus on its cost effectiveness. Though indications are similar with standard endoscopy, small caliber endoscopy can be preferred in patients with gastrointestinal stenosis. Less common indications include transnasal endoscopic retrograde cholangiography and postpyloric feeding tube insertion. The esophagogastroduodenoscopy procedure with small caliber endoscopes is easy to perform, and there is generally no need for further training for this technique. However, the additional cost of equipment and some medicolegal and technical issues have resulted in the unpopularity of small caliber endoscopy in most countries other than France and Japan. However, sharing information about this technique and stressing its potential advantages can help in its widespread use in various countries including Turkey. We believe that routine use of small caliber endoscopes during daily gastrointestinal endoscopy practice is not far away in many countries.

Autofluorescence imaging and magnification endoscopy

It is well known that angiogenesis is critical in the transition from premalignant to malignant lesions. Consequently, early detection and diagnosis based on morphological changes to the microvessels are crucial. In the last few years, new imaging techniques which utilize the properties of light-tissue interaction have been developed to increase early diagnosis of gastrointestinal (GI) tract neoplasia. We analyzed several "red-flag" endoscopic techniques used to enhance visualization of the vascular pattern of preneoplastic and neoplastic lesions (e.g. trimodal imaging including autofluorescence imaging, magnifying endoscopy and narrow band imaging). These new endoscopic techniques provide better visualization of mucosal microsurface structure and microvascular architecture and may enhance the diagnosis and characterization of mucosal lesions in the GI tract. In the near future, it is expected that trimodal imaging endoscopy will be practiced as a standard endoscopy technique as it is quick, safe and accurate for making a precise diagnosis of gastrointestinal pathology, with an emphasis on the diagnosis of early GI tract cancers. Further large-scale randomized controlled trials comparing these modalities in different patient subpopulations are warranted before their endorsement in the routine practice of GI endoscopy.

Polypectomy devices

Polypectomy devices

Endoscopy in patients with implanted electronic devices

Endoscopy in patients with implanted electronic devices

Impact of Non-Gastroenterologists Performing Gastrointestinal Endoscopy on the Practice of Gastroenterologists and Variations in Practice of Gastrointestinal Endoscopy by Non-Gastroenterologist Endoscopists and Gastroenterologists in Georgia, United States

Impact of Non-Gastroenterologists Performing Gastrointestinal Endoscopy on the Practice of Gastroenterologists and Variations in Practice of Gastrointestinal Endoscopy by Non-Gastroenterologist Endoscopists and Gastroenterologists in Georgia, United States

Measuring the quality of endoscopy

The practice of gastrointestinal endoscopy is facing a crisis. There is decreasing reimbursement for endoscopic procedures in the face of increasing demand. We are challenged to assess the quality of the services we provide. Although providing the best possible patient care is our most important goal, we are poorly equipped to measure our ability to achieve that goal.

Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures

This is one of a series of statements discussing the practice of gastrointestinal endoscopy in common clinical situations. It is intended to aid endoscopists in determining the appropriate use of endoscopic procedures in conjunction with anticoagulation and/or antiplatelet therapy. Guidelines for the appropriate practice of endoscopy are based on critical review of the available data and expert consensus. Controlled clinical studies would be beneficial to clarify some aspects of this statement and revision might be necessary as new data appear. Clinical consideration may justify a course of action at variance from these specific recommendations.

7030 Gastrointestinal endoscopy in a large urban medical center i: esophagogastroduodenoscopy (egd).

Few data exist to describe the practice of gastrointestinal endoscopy in a large urban county hospital. These data represent our experience with EGD at Kings County Hospital (KCHC) during the period 1/97 - 5/99. 767 EGDs were perfromed on 397 men (mean age = 52.4 years) and 362 women (mean age = 57.2). 87.7% were done electively in the GI endoscopy suite, and 12.3% were emergency cases done in the ER (7.3%), the MICU (2.3%), SICU (2.3%), or NICU (0.3%). A therapeautic technique was included in 10% of the procedures. Active or recent UGI bleeding was the most common indication (40%) for EGD. Other indications included epigastric pain (22.3%), dysphagia (5.6%), occult GI bleeding with or without iron deficiency anemia (5.1%), and others (27%). 30% of all examinations were performed with no conscious sedation. The rates for successful completion of emergency and routine procedures were 81% and 90% respectively. Endoscopic diagnoses included esophagitis (19.2%), hiatus hernia (19.2%), candida esophagitis (4.6%), esophageal ulcer (4.0%), esophageal varices (3.9%), Mallory Weiss tear (3.3%), Barrett's esophagus (1.3%), esophageal cancer (2.1%), gastritis (31.9%), gastric ulcer (16.8%), gastric cancer (3.3%), gastric polyp (0.9%), duodenitis (15.4%), duodenal ulcer (12.9%), duodenal polyp (0.9%), abnormal papilla (0.7%), active bleed with no source (0.7%) and normal study (8%). There were only two complications (0.3%), both micro-perforations of the cervical esophagus requiring no invasive treatment. Conclusions: A major fraction of EGD in a large urban inner-city county hospital are done for upper GI bleeding. Many procedures are performed without sedation. The incomplete procedure rate is high, but the complication rate is low. The frequency of normal study is low while 10% of all EGD include a therapeautic technique.

Complications of Conscious Sedation

Complications are a part of the practice of medicine. This is amply true for gastrointestinal endoscopy. The medications currently used in the practice of gastrointestinal endoscopy are essential to our ability to perform the wide array of diagnostic and therapeutic procedures that have become the hallmark of modern day gastroenterology. As in all of medicine, a decision is based on an assessment of risk versus benefit. Yes, these medications do carry risk with their use; however, with proper preparation and careful administration, the benefits derived far exceed the risks. We are able to perform a host of endoscopic surgical procedures precluding higher risk alternatives; patients are saved the anxiety and discomfort associated with the procedure and, in situations where follow-up procedures are necessary, they usually are more than willing to return. Maintaining these gains is the responsibility of the gastrointestinal endoscopist community and requires the recognition of the risks and a continuous effort to minimize them.

Antibiotic Prophylaxis For Gastrointestinal Endoscopy

This is one of a series of statements discussing the practice of gastrointestinal endoscopy in common clinical situations. It is intended to aid endoscopists in determining the appropriate use of antibiotic prophylaxis for patients undergoing gastrointestinal endoscopic procedures. Guidelines for the appropriate practice of endoscopy are based on a critical review of the available data and expert consensus. Controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance from these recommendations. Recommendations on prophylaxis against infective endocarditis were developed in conjunction with the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease of the Council of Cardiovascular Disease in the Young of the American Heart Association.

Risk Management in Endoscopic Practice

As illustrated, the practice of gastrointestinal endoscopy is not without risks. All physicians who perform endoscopy should be mindful of the tenets of risk management and how they apply to their endoscopic practices. Retrospective review of individual endoscopic practice habits should be performed yearly and modifications made where necessary. Hospital quality assurance committees should have gastrointestinal endoscopist representation. These committees should have as a component of their responsibilities a commitment to physician education.

Prevention of Hospital Liability for Granting Privileges to Unqualified Physicians

The rise in medical malpractice claims has resulted in the widespread development of risk management programs. These programs have relevance to the practice of gastrointestinal endoscopy with regard to identifying and addressing factors that place the gastrointestinal endoscopist and his or her patient at risk for procedure-related complications and adverse outcomes. Illustrative clinical examples and commentary regarding gastrointestinal endoscopy as it relates to the tort of professional liability are provided. Recommendations regarding gastrointestinal risk management are formulated.

Who Should Be Doing Gastrointestinal Endoscopy?

THE QUESTION of who should be doing gastrointestinal (GI) endoscopy is a problem that confronts hospital committees charged with granting endoscopic privileges.¹The Joint Commission on Accreditation of Hospitals requires that individual medical staffs set criteria for privileges and have a process for delineation of these privileges. The Federation of Digestive Disease Societies has approved<i>Guidelines for Training in Endoscopy</i>²and the American Society for Gastrointestinal Endoscopy has prepared<i>Guidelines for Standards of Practice of Gastrointestinal Endoscopy</i>.³These two documents may guide hospital committees and require further interpretation in that event. <h3>Training Guidelines</h3> The<i>Guidelines for Training</i>apply to residency-fellowship programs and, when adhered to, provide for physicians who are skillful in the ability both to perform endoscopy and to relate the procedures to the care of the patient. Some gastroenterologists as well as many general and colorectal surgeons have not had their training in programs that

Who should be doing gastrointestinal endoscopy?

THE QUESTION of who should be doing gastrointestinal (GI) endoscopy is a problem that confronts hospital committees charged with granting endoscopic privileges.¹The Joint Commission on Accreditation of Hospitals requires that individual medical staffs set criteria for privileges and have a process for delineation of these privileges. The Federation of Digestive Disease Societies has approved<i>Guidelines for Training in Endoscopy</i>²and the American Society for Gastrointestinal Endoscopy has prepared<i>Guidelines for Standards of Practice of Gastrointestinal Endoscopy</i>.³These two documents may guide hospital committees and require further interpretation in that event. <h3>Training Guidelines</h3> The<i>Guidelines for Training</i>apply to residency-fellowship programs and, when adhered to, provide for physicians who are skillful in the ability both to perform endoscopy and to relate the procedures to the care of the patient. Some gastroenterologists as well as many general and colorectal surgeons have not had their training in programs that