Feasibility and safety of endoscopic evaluation of gastric emptying

Transient delayed gastric emptying following laparoscopic Nissen fundoplication for gastroesophageal reflux disease

PURPOSE

Although laparoscopic Nissen fundoplication (LNF) is a kind of minimally invasive surgery, some transition time may still be required to allow the fundoplicated stomach to adapt to the new anatomical position. We observed transient delayed gastric emptying (DGE) post-LNF in our preliminary study. This study aimed to investigate the occurrence rate and development of transient DGE post-LNF.

METHODS

Patients who underwent LNF for gastroesophageal reflux disease (GERD) at our institution were recruited consecutively. They were treated with standardized LNF and prospectively followed up for 2 months. Proper diet guidance and/or pharmacologic therapy were given during these 2 months. GERD Health-Related Quality of Life (GERD-HRQL), DGE symptoms, and DGE status were evaluated preoperatively and postoperatively.

RESULTS

Fifty-one patients underwent LNF and completed a 2-month follow-up. LNF succeeded in all patients. Prior to LNF, no DGE was identified. At the 1-month follow-up, LNF led to a significant reduction in the GERD-HRQL total score but a significantly increased DGE score. Endoscopically, DGE was identified in forty-seven (n = 47, 92.2%) patients. At the 2-month follow-up, the GERD-HRQL scores continued to show decreases compared to the 1 month. The DGE score returned to the baseline value. Endoscopically, no DGE was identified in any patients (n = 0, 0.0%).

CONCLUSIONS

Transient DGE is a very common one-month post-LNF but can recover quickly in the second month following LNF.

Endoscopic evaluation of gastric emptying and effect of mosapride citrate on gastric emptying

PURPOSE

Gastric emptying has been evaluated by scintigraphy in spite of its limitations of time consumption, cost, and danger of radioisotope. Endoscopy is a simple technique, however, its validation for gastric emptying and quantification of food has not yet been investigated. The aim of our study was to assess endoscopic gastric emptying compared with scintigraphy and radiopaque markers (ROMs) studies. We also investigated the effect of a single dose of mosapride on gastric emptying.

MATERIALS AND METHODS

Fifteen healthy volunteers underwent scintigraphy. Next day, subjects received a standard solid meal with ROMs and underwent endoscopy and simple abdomen X-ray after 3 hrs. After one week, the same procedure was repeated after ingestion of mosapride (5 mg for group 1, n = 8; 10 mg for group 2, n = 7) 15 min before the meal. Quantification of gastric residue by endoscopy was scored from 0 to 3, and the scores were added up.

RESULTS

All subjects completed the study without any complication. The gastric emptying rate [T(1/2) (min)] was in normal range (65.6 +/- 12.6 min). Endoscopic gastric emptying was correlated significantly with gastric clearance of ROMs (r = 0.627, p = 0.012). Endoscopic gastric emptying and gastric clearance of ROMs after administration of mosapride showed significant differences in the 10 mg group (p < 0.05).

CONCLUSION

Endoscopy can evaluate gastric emptying safely and simply on an outpatient basis. A 10 mg dose of mosapride enhanced gastric emptying, assessed by both endoscopy and ROMs.

Functional oesophagoscopy: endoscopic evaluation of the oesophageal phase of deglutition

BACKGROUND

The anatomy and function of the oropharynx and larynx during deglutition can be assessed using the flexible endoscope, but this evaluation does not provide information on the oesophagus. Guided observation of oesophageal swallowing enables extended dysphagia evaluation.

OBJECTIVE

To assess the diagnostic utility of guided observation of oesophageal swallowing in the evaluation of dysphagia.

STUDY DESIGN

Retrospective case series.

METHODS

Procedures for guided observation of oesophageal swallowing were reviewed for oesophageal findings and compared with fluoroscopy and manometry.

RESULTS

Twenty-one patients underwent guided observation of oesophageal swallowing and concurrent videofluoroscopy and/or manometry. No complications of the former procedure occurred. The results of guided observation of oesophageal swallowing concurred with those of fluoroscopy in 15/21 cases (71 per cent) and with those of manometry in five of six (83 per cent) cases. Guided observation of oesophageal swallowing revealed anatomic pathology contributing to dysphagia in 15/21 (71 per cent) patients. The procedure identified pathology not detected by fluoroscopy and manometry in 13/21 (62 per cent) patients.

CONCLUSION

Guided observation of oesophageal swallowing appears to be a safe diagnostic tool with which to evaluate the oesophageal phase of deglutition.

Transnasal route: new approach to endoscopy

Transnasal esophagogastroduodenoscopy (TN-EGD) has recently become one of the frequently used methods of upper gastrointestinal endoscopy in some countries. Changes in blood pressure, heart rate, and oxygen saturation are smaller for TN-EGD than for conventional transoral esophagogastroduodenoscopy, making it a safer procedure. Lower pain and gag reflex enable TN-EGD to be performed without conscious sedation. TN-EGD is applied in various gastrointestinal (GI) procedures such as percutaneous endoscopic gastrostomy, nasoenteric feeding tube placement, endoscopic retrograde cholangiopancreaticography with nasobiliary drainage and lithotripsy, long intestinal tube placement in small-bowel obstruction, esophageal manometry, foreign body removal, botulinum toxin injection for achalasia, esophageal varix evaluation with the aid of endoscopic ultrasonography, and the double-scope technique for endoscopic submucosal dissection. The establishment of standard training programs and nationwide guidelines, the dissemination of educational information, the improvement in endoscopy devices and accessories, and the availability of insurance coverage for the procedure will obviously further widen the adoption of TN-EGD.

Endoscopic-guided versus cotton-tipped applicator methods of nasal anesthesia for transnasal esophagogastroduodenoscopy: a randomized, prospective, controlled study

BACKGROUND

Ultrathin transnasal esophagogastroduodenoscopy (UT-EGD) is well tolerated by patients, but the methods of nasal anesthesia are various.

AIM

To compare patient tolerance, safety, and adverse events between the endoscopic-guided (EGNA) and cotton-tipped applicator (CTNA) methods of nasal anesthesia.

METHODS

Between September 2005 and September 2006, we conducted a prospective, randomized, controlled study in a large tertiary referral hospital in eastern Taiwan. In total, 235 consecutive patients were randomly assigned to the CTNA group or EGNA group before unsedated UT-EGD. We compared demographic data, procedural discomfort using a validated 5-point visual analog scale, optical quality, total procedure time, and adverse events between the two groups.

RESULTS

After randomization and exclusion, 101 (43 men and 58 women) and 103 (44 men and 59 women) patients were allocated to the CTNA and EGNA groups, respectively. Baseline characteristics and periprocedural hemodynamics of patients in the two groups were similar. There was no statistical difference in insertion failure rates between the two methods (CTNA 10.9%vs EGNA 7.7%, P= 0.59). Pain scores during both anesthesia (2.3 +/- 0.4 vs 3.5 +/- 0.6, P < 0.001) and insertion (2.8 +/- 1.2 vs 3.8 +/- 1.8, P < 0.001) were significantly lower in the EGNA group; however, the sensation of bad taste was significantly worse in the EGNA group (2.3 +/- 1.3 vs 1.9 +/- 1.4, P= 0.040). Less epistaxis happened in the EGNA group than in the CTNA group. The EGNA method had a significantly better visual capacity and shorter procedure time. More patients in the EGNA group said they would like to receive the same procedure the next time.

CONCLUSION

Compared with the CTNA method, in which the taste of lidocaine gel was more acceptable, EGNA appeared to be more tolerable, caused less epistaxis, improved visualization capacity, and reduced procedure time.