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Beaton DR, Sharp L, Lu L, Trudgill NJ, Thoufeeq M, Nicholson BD, Rogers P, Docherty J, Jenkins A, Morris AJ, Rösch T, Rutter MD. Diagnostic yield from symptomatic gastroscopy in the UK: British Society of Gastroenterology analysis using data from the National Endoscopy Database. Gut 2024:gutjnl-2024-332071. [PMID: 38697772 DOI: 10.1136/gutjnl-2024-332071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation. DESIGN A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett's oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated. RESULTS 382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged <50 and 57.7% on female patients. The overall unadjusted PPV for cancer was 1.0% (males 1.7%; females 0.6%, p<0.01). Other major pathology was found in 9.1% of procedures, whereas 89.9% reported only normal findings or minor pathology (92.5% in females; 94.6% in patients <50).Highest cancer aPPVs were reached in the over 50s (1.3%), in those with dysphagia (3.0%) or weight loss plus another symptom (1.4%). Cancer aPPVs for all other symptoms were below 1%, and for those under 50, remained below 1% regardless of symptom. Overall, 73.7% of gastroscopies were carried out in patient groups where aPPV cancer was <1%.The overall unadjusted PPV for BO was 4.1% (males 6.1%; females 2.7%, p<0.01). The aPPV for BO for reflux was 5.8% and ranged from 3.2% to 4.0% for other symptoms. CONCLUSIONS Cancer yield was highest in elderly male patients, and those over 50 with dysphagia. Three-quarters of all gastroscopies were performed on patients whose cancer risk was <1%, suggesting inefficient resource utilisation.
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Affiliation(s)
- David Robert Beaton
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Mo Thoufeeq
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian D Nicholson
- University of Oxford Department of Primary Care Health Sciences, Oxford, UK
| | | | | | | | | | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf Department of Interdisciplinary Endoscopy, Hamburg, Germany
| | - Matthew D Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
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Saunsbury E, Haddadin Y, Gadhok R, Ratcliffe E, Raju SA. UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come. Frontline Gastroenterol 2024; 15:35-41. [PMID: 38487564 PMCID: PMC10935528 DOI: 10.1136/flgastro-2023-102468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Shape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views. Method The British Society of Gastroenterology Trainees Section collected anonymised survey responses from trainees between June and September 2022 via an online platform. Results 40.3% of trainees responded. Strikingly, only 10% of respondents felt they could achieve certificate of completion of training (CCT) within a 4-year programme. Furthermore, 31% were not confident they would attain the required expertise in their subspecialist interest during training. 70.8% reported spending a quarter or more of their training in general internal medicine (GIM) and 71.6% felt this negatively impacted on their gastroenterology training. Only 21.6% of respondents plan to pursue a consultant post with GIM commitments.Regarding endoscopy, only 36.1% of ST7s had provisional and 22.2% full accreditation in colonoscopy. Although 92.3% of respondents wanted exposure to a 'bleed rota', this was the case for only 16.2%. Teaching quality was judged to be insufficient by 45.9% of respondents. Conclusion Respondents had struggled to achieve the necessary competencies for CCT even prior to the newly reduced 4-year curriculum. While still maintaining service provision, we must safeguard gastroenterology training from encroaching GIM commitments. This will be critical in order to provide capable consultants of the future and prevent UK standards from falling behind internationally.
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Affiliation(s)
- Emma Saunsbury
- Department of Hepatology, John Radcliffe Hospital, Oxford, UK
| | - Yazan Haddadin
- Department of Clinical and Experimental Medicine, University of Sussex, Brighton, UK
| | - Radha Gadhok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Elizabeth Ratcliffe
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust Rochdale Care Organisation, Rochdale, UK
| | - Suneil A Raju
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Hannemann A, Mayerle J, Beyer G. Response to: Correspondence on 'Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP: still needed further discussion' by Wang et al. Gut 2023:gutjnl-2023-331525. [PMID: 38050096 DOI: 10.1136/gutjnl-2023-331525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Partner Site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine II, Ludwig Maximilian University of Munich, Munchen, Bayern, Germany
| | - Georg Beyer
- Department of Medicine II, Ludwig Maximilian University of Munich, Munchen, Bayern, Germany
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Beaton D, Rutter M, Sharp L, Oppong KW, Awadelkarim B, Everett SM, Mitra V. UK ERCP sedation practices, patient comfort and endoscopist characteristics: National Endoscopy Database (NED) analysis on behalf of the JAG and BSG. Frontline Gastroenterol 2023; 14:384-391. [PMID: 37581181 PMCID: PMC10423606 DOI: 10.1136/flgastro-2023-102424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/19/2023] [Indexed: 08/16/2023] Open
Abstract
Objectives This analysis assessed current endoscopic retrograde cholangiopancreatography (ERCP) practice within the UK, including use of sedation and patient comfort. Methods ERCPs conducted over 1 year (1 July 2021-30 June 2022) and uploaded to the National Endoscopy Database (NED) were analysed. The endoscopist workforce was classified by gender and specialty, use of sedation was analysed. Logistic regression was used to assess associations between patient age, gender and procedure indications on moderate to severe discomfort risk. Results 27 812 ERCPs were performed by 491 endoscopists in 175 sites and uploaded to NED, an estimated 50% of total UK activity. 13% were training procedures, 94% of the endoscopists were male, with 72% being gastroenterologists. Most ERCPs were performed under conscious sedation (89%). The discomfort rate among patients aged 60-90 undergoing ERCP under conscious sedation was 4.2% (95% CI 3.9% to 4.5%), with only 5.5% (95% CI 5.2% to 5.9%) receiving greater than 5 mg midazolam or 100 µg fentanyl.Younger patients (<30 years) had a higher discomfort risk during conscious sedation ERCPs than those aged 70-79 (OR 3.0, 95% CI 2.2 to 4.3, p<0.05), while male patients had a lower discomfort risk compared with females (OR 0.9, 95% CI 0.8 to 1.0, p=0.05).Enhanced sedation (propofol or general anaesthetic) was associated with lower frequency of discomfort (0.3%, 95% CI 0.1 to 0.6) compared with conscious sedation (5.1%, 95% CI 4.9% to 5.4%, p<0.05). Conclusions Conscious sedation is well tolerated for most patients and prescribing practices have improved. However, triage of more patients, particularly young females, to enhanced sedation lists should be considered to reduce discomfort rates in future.
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Affiliation(s)
- David Beaton
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Matt Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Newcastle University, Newcastle upon Tyne, UK
| | - Kofi W Oppong
- Hepatobiliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Simon M Everett
- Gastroenterology, St James's University Hospital NHS Trust, Leeds, UK
| | - Vikramjit Mitra
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
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Kane SV, Reau N. Clinical advances: pregnancy in gastroenterologic and hepatic conditions. Gut 2023; 72:1007-1015. [PMID: 36759153 DOI: 10.1136/gutjnl-2022-328893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
The fields of gastroenterology and hepatology, along with endoscopic practice, have seen significant changes and innovations to practice in just the past few years. These practice changes are not limited to gastroenterology, but maternal fetal medicine and the care of the pregnant person have become increasingly more sophisticated as well. Gastroenterologists are frequently called on to provide consultative input and/or perform endoscopy during pregnancy. To be able to provide the best possible care to these patients, gastroenterologists need to be aware of (and familiar with) the various nuances and caveats related to the care of pregnant patients who either have underlying gastrointestinal (GI) conditions or present with GI and liver disorders. Here, we offer a clinical update with references more recent than 2018, along with a few words about SARS-CoV-2 infection and its relevance to pregnancy.
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Affiliation(s)
- Sunanda V Kane
- Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Nancy Reau
- Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Simmons J, Sherif A, Mader J, Altarawneh S, El-Hamdani M, Frandah W. Closure of recurrent colovaginal fistulas using AMPLATZER occluder device. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000921. [PMID: 35701008 PMCID: PMC9198781 DOI: 10.1136/bmjgast-2022-000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/29/2022] [Indexed: 11/04/2022] Open
Abstract
A 79-year-old woman and a 92-year-old woman were referred to the gastroenterology department for management of persistent colovaginal fistula despite surgical and non-surgical management. Both patients had several hospitalisations for recurrent urinary tract infections. After failed surgical management and endoscopy using over-the-scope clipping, both patients underwent endoscopic closure using the Amplatzer cardiac septal occluder device. Both patients underwent successful closure and had no recurrence of symptoms at 6-month follow-up. Although there are several therapies available for persistent colovaginal fistulas, most involve multiple sessions and have high recurrence rate. There have been reports in the literature of cardiac septal occluders being used in the management of upper gastrointestinal tract fistulas, but few cases exist explaining their role in the management of colovaginal fistulas. Our cases demonstrate that cardiac septal occluders may be a viable option for management of fistulas and warrants further studies to reproduce its effectiveness and safety.
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Affiliation(s)
- Joseph Simmons
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Ahmed Sherif
- Department of Gastroenterology and Hepatology, Marshall University, Huntington, West Virginia, USA
| | - Jason Mader
- Department of Cardiovascular Services, Marshall University, Huntington, West Virginia, USA
| | - Saba Altarawneh
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Mehiar El-Hamdani
- Department of Cardiovascular Services, Marshall University, Huntington, West Virginia, USA
| | - Wesam Frandah
- Department of Gastroenterology and Hepatology, Marshall University, Huntington, West Virginia, USA
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7
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O'Hara J, Fisher H, Hayes L, Wilson J. 'Persistent throat symptoms' versus 'laryngopharyngeal reflux': a cross-sectional study refining the clinical condition. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000850. [PMID: 35338049 PMCID: PMC8961157 DOI: 10.1136/bmjgast-2021-000850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Many patients are assessed for chronic symptoms including: dysphonia, ‘globus’, throat clearing, postnasal secretions and cough; commonly grouped together and attributed to ‘laryngopharyngeal reflux’. This study aimed to explore a clinical trial’s baseline dataset for patterns of presenting symptoms, which might provide a more rational basis for treatment. Design Baseline data were analysed for participants entering the Trial Of Proton-Pump Inhibitors in Throat Symptoms: age, body mass index, Reflux Symptom Index, Comprehensive Reflux Symptom Score, Laryngopharyngeal Reflux-Health-related Quality of Life questionnaire and Reflux Finding Score (RFS-endoscopic examination). The relationships between the questionnaires and demographic factors were assessed. Exploratory factor analysis (EFA) was conducted on individual symptom items in the combined questionnaires. The EFA factors were applied to a Cluster Analysis of participants, to explore the presence of identifiable patient. Results Throat clearing and globus were the highest ranked scores in the 344 participants. Increasing age was inversely associated with symptom severity (p<0.01). There was no relationship between the RFS and any of the three questionnaires. EFA resulted in a seven-factor model with clinically meaningful labels: voice, cough, gastrointestinal symptoms, airway symptoms and dysphagia, throat clearing, lump in throat, and life events. Cluster analysis failed to demonstrate any clinically meaningful clusters of patients. Conclusion This study offers a framework for future research and demonstrates that individual symptoms cannot be used to group patients. The analysis supports the use of a broad ‘umbrella’ term such as persistent throat symptoms. Trial registration number ISRCTN38578686.
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Affiliation(s)
- James O'Hara
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK james.o'.,Department of Otolaryngology - Head and Neck Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Holly Fisher
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Janet Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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8
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Kumar S, Ramos C, Garcia-Carrasquillo RJ, Green PH, Lebwohl B. Incidence and risk factors for gastrointestinal bleeding among patients admitted to medical intensive care units. Frontline Gastroenterol 2017; 8:167-173. [PMID: 28839905 PMCID: PMC5558277 DOI: 10.1136/flgastro-2016-100722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To identify incidence and risk factors for new-onset gastrointestinal bleeding (GIB) in a medical intensive care unit (ICU), a topic for which there is a paucity of recent studies. DESIGN Retrospective cohort study. SETTING Medical ICUs at our tertiary-care hospital, from 2007 to 2013. PATIENTS Patients who developed clinically significant GIB after entering the ICU. INTERVENTIONS Univariable and multivariable analyses. MAIN OUTCOME MEASURES Incidence and risk factors for development of GIB. RESULTS 4439 patients entered the medical ICU without a pre-existing GIB and 58 (1.3%) developed GIB while in the ICU. Risk factors included length of ICU stay (OR per additional day 1. 06; 95% CI 1.04 to 1.09) and elevated creatinine on ICU admission (OR 2.35; 95% CI 1.18 to 4.68, p=0.02). Elevated bilirubin on ICU admission (OR 2.08; 95% CI 0.97 to 4.47, p=0.06), and elevated aspartate transaminase (AST) on ICU admission (OR 2.20; 95% CI 0.96 to 5.03, p=0.06) trended towards increased risk of GIB that did not meet statistical significance. Age, gender, admission coagulation studies and mechanical ventilation were not predictive of GIB. Among those patients with new-onset GIB in the ICU, 47% died during that hospitalisation, as compared with those 30% of those without a GIB, p<0.01. CONCLUSIONS Onset of GIB is now an infrequent occurrence in the ICU setting; however those with elevated bilirubin, AST and creatinine upon admission, and with longer length of ICU stay appear at increased risk and may benefit from closer monitoring.
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Affiliation(s)
- Shria Kumar
- Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Christopher Ramos
- Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Reuben J Garcia-Carrasquillo
- Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Peter H Green
- Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, New York, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Abstract
In the last 20 years, endoscopic retrograde cholangiopancreatography (ERCP) has evolved from being a diagnostic procedure to being almost exclusively therapeutic. Similarly, endoscopic ultrasound (EUS) is developing into ever-increasing therapeutic roles. Operator technique is central to diagnostic accuracy in EUS, as is effective and safer therapy for both ERCP and therapeutic EUS. Hence, effective training and robust standards for certification and revalidation are required to ensure ERCP and EUS in the UK are as effective and as safe as possible.
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Affiliation(s)
- Noor LH Bekkali
- GI Services, University College London Hospitals, London, UK,Pancreatobiliary Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Gavin J Johnson
- GI Services, University College London Hospitals, London, UK
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10
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Oppong K. Advancing the diagnostic and therapeutic role of EUS in pancreaticobiliary disease: Hopkins Lecture 2016. Frontline Gastroenterol 2017; 8:115-118. [PMID: 28839895 PMCID: PMC5369446 DOI: 10.1136/flgastro-2016-100759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 02/04/2023] Open
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Murino A, Despott EJ. Small bowel endoluminal imaging (capsule and enteroscopy). Frontline Gastroenterol 2017; 8:148-151. [PMID: 28839900 PMCID: PMC5369435 DOI: 10.1136/flgastro-2016-100765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 12/11/2016] [Indexed: 02/04/2023] Open
Abstract
Over the last 16 years, the disruptive technologies of small bowel capsule endoscopy and device-assisted enteroscopy have revolutionised endoluminal imaging and minimally invasive therapy of the small bowel. Further technological developments continue to expand their indications and use. This brief review highlights the state-of-the-art in this arena and aims to summarise the current and potential future role of these technologies in clinical practice.
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Affiliation(s)
- Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
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12
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Parker C, Alexandridis E, Plevris J, O'Hara J, Panter S. Transnasal endoscopy: no gagging no panic! Frontline Gastroenterol 2016; 7:246-256. [PMID: 28839865 PMCID: PMC5369487 DOI: 10.1136/flgastro-2015-100589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. METHODS A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. RESULTS There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORD-associated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes. CONCLUSIONS TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.
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Affiliation(s)
- Clare Parker
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | | | - John Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - James O'Hara
- Department of Otolaryngology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, Newcastle upon Tyne, UK
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Sakata S, Grove PM, Stevenson ARL, Hewett DG. The impact of three-dimensional imaging on polyp detection during colonoscopy: a proof of concept study. Gut 2016; 65:730-1. [PMID: 26896460 DOI: 10.1136/gutjnl-2016-311507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/05/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Shinichiro Sakata
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Philip M Grove
- School of Psychology, The University of Queensland, Brisbane, Australia
| | | | - David G Hewett
- School of Medicine, The University of Queensland, Brisbane, Australia
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14
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Bill JG, Kushnir VM, Mullady DK, Murad FM, Azar RR, Easler JJ, Early DS, Edmundowicz SA. Evaluation of patients with abnormalities on intraoperative cholangiogram: time to abandon endoscopic retrograde cholangiopancreatography as the initial follow-up study. Frontline Gastroenterol 2016; 7:105-109. [PMID: 28839843 PMCID: PMC5369474 DOI: 10.1136/flgastro-2015-100597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is currently the method of choice for the postoperative evaluation of suspected bile duct stones seen on intraoperative cholangiogram (IOC); however, the sensitivity of IOC for identifying biliary pathology is unclear, with studies reporting false positive rates between 30% and 60%. OBJECTIVE Evaluate the sensitivity of IOC for biliary pathology, using ERCP with sphincterotomy and balloon sweep as gold standard. DESIGN Retrospective cohort study. SETTING Tertiary medical centre. PATIENTS 130 consecutive patients (age 51.3±1.7 years, 69.2% women) who underwent ERCP for the evaluation of abnormalities identified on IOC between 2005 and 2013. INTERVENTIONS Endoscopic retrograde cholangiopancreatography. MAIN OUTCOME MEASUREMENTS Sensitivity of IOC, identify predictors of positive postoperative ERCP and ERCP-related complications. RESULTS ERCP was successful in all 130 subjects. ERCP-related adverse events occurred in six (4.3%) patients, including self-limited post-sphincterotomy bleeding in three (2.3%) and mild post-ERCP pancreatitis in three (2.3%). Overall, 41 (31.5%) patients had normal cholangiogram at time of ERCP. Finding of a filling defect on IOC was the only predictor for the presence of common bile duct stones on postoperative ERCP (OR 3.3, 95% CI 1.0 to 10.8, p=0.05). LIMITATIONS Retrospective study design. CONCLUSIONS Nearly one-third of patients with abnormal IOC had a normal postoperative ERCP. Significant pathology could have been missed in 1/130 patients. Based on these findings, we believe the use of less-invasive diagnostic modalities may be used in place of ERCP in patients with suspected choledocholithiasis on IOC.
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Affiliation(s)
- Jason G Bill
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Daniel K Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Faris M Murad
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Riad R Azar
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffery J Easler
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Dayna S Early
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Steven A Edmundowicz
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
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15
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Dowman JK, Ditchburn L, Chapman W, Lidder P, Wootton N, Ryan N, Cooney RM. Observed high incidence of buried bumper syndrome associated with Freka PEG tubes. Frontline Gastroenterol 2015; 6:194-198. [PMID: 28839810 PMCID: PMC5369583 DOI: 10.1136/flgastro-2014-100503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/26/2014] [Accepted: 11/01/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Buried bumper syndrome (BBS) is an uncommon but significant complication of percutaneous endoscopic gastrostomy (PEG), which occurs due to overgrowth of gastric mucosa over the inner bumper of the gastrostomy tube. A high incidence of BBS was observed in patients with Freka PEG tubes. OBJECTIVE To review case numbers of BBS and confirm the observed association with Freka tubes to determine whether change of practice should be considered. DESIGN Data was collected on the number of cases of BBS reported to the community nutrition team Birmingham, UK. Data on type of PEG kit and total number of PEGs inserted between 2009 and 2013 were collected. The electronic endoscopy reporting database was used to compare case numbers of BBS in our Trust in years when Corflo and Freka PEG tubes were used, respectively. Data from our Trust were also compared with that from a Trust using Corflo only. RESULTS Fifty-eight cases of BBS were reported in the area covered by the Birmingham community nutrition team between 2009 and 2013, all of which were associated with Freka PEG tubes. An estimated 1000-1200 PEGs were inserted during this period, representing an incidence of BBS of 4.8-5.8%. No cases of BBS occurred over the same period in the comparison Trust (451 Corflo PEGs inserted). CONCLUSIONS Our review confirmed our observation of an increased risk of BBS with Freka PEG tubes. Clinicians should be aware of our findings when deciding which brand of PEG tube to insert, particularly in patients with a previous history of BBS.
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Affiliation(s)
- Joanna K Dowman
- Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, UK
| | - Linda Ditchburn
- Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, UK
| | - Warren Chapman
- Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, UK
| | - Par Lidder
- Sandwell and West Birmingham NHS Trust, Sandwell General Hospital, West Bromwich, UK
| | - Nicola Wootton
- Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, UK
| | - Nicola Ryan
- Sandwell and West Birmingham NHS Trust, Sandwell General Hospital, West Bromwich, UK
| | - Rachel M Cooney
- Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, UK
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16
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Yang D, Summerlee R, Rajca B, Williamson JB, LeLaurin J, McClellan L, Collins D, Sultan S. A pilot study to evaluate the feasibility of implementing a split-dose bowel preparation for inpatient colonoscopy: a single-center experience. BMJ Open Gastroenterol 2015; 1:e000006. [PMID: 26462263 PMCID: PMC4533324 DOI: 10.1136/bmjgast-2014-000006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/03/2014] [Accepted: 08/14/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Feasibility of using split-dose bowel preparation in an inpatient setting has not been extensively studied. We conducted a single-centre multiphase study to (1) understand the perceived barriers to split-dose administration among nursing and providers, (2) develop and implement a split-dose electronic order set and (3) evaluate the use and impact of split-dose administration on 100 consecutive colonoscopies. METHODS Nurse/provider interviews were conducted to understand perceived concerns and potential barriers to split-dose preparation. Next, an order set containing specific nursing instructions was developed, disseminated and implemented into the electronic health record as the default order set for inpatient colonoscopies. Finally, 100 consecutive inpatients undergoing colonoscopy were interviewed to determine prep consumption, tolerability and rate of procedural delays due to inadequate preparation. RESULTS Survey results indicated perceived concerns about inpatients' ability to tolerate and complete the preparation, insufficient nursing support and complexity of preparation administration. Based on this, prep orders were adjusted to accommodate nursing concerns prior to implementation. 54% of inpatients actually completed the bowel preparation in split doses (SPLIT group); the remainder had the conventional full dose preparation (NON-SPLIT). Less procedural delay and a lower rate of additional laxatives use (13% vs 30.4%) were seen in the SPLIT versus NON-SPLIT group. Split-dose preparation was well tolerated among inpatients. CONCLUSIONS Split-dose bowel preparation can be implemented for inpatients undergoing colonoscopy. This multiphase study demonstrates the steps used to implement split-dose preparation at our institution and may provide others with strategies that they could use at their institutions.
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Affiliation(s)
- Dennis Yang
- Division of Gastroenterology and Hepatology , University of Florida , Gainesville, Florida , USA
| | - Robert Summerlee
- Division of Gastroenterology and Hepatology , University of Florida , Gainesville, Florida , USA
| | - Brian Rajca
- Division of Gastroenterology and Hepatology , University of Florida , Gainesville, Florida , USA
| | - Jonathan B Williamson
- Division of Gastroenterology and Hepatology , University of Florida , Gainesville, Florida , USA
| | - Jennifer LeLaurin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | | | - Dennis Collins
- Division of Gastroenterology and Hepatology , University of Florida , Gainesville, Florida , USA ; Gastroenterology Section, Minneapolis VAHS, Minneapolis, Minnesota, USA
| | - Shahnaz Sultan
- Division of Gastroenterology and Hepatology , University of Florida , Gainesville, Florida , USA ; Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA ; Gastroenterology Section, Minneapolis VAHS, Minneapolis, Minnesota, USA
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