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7117 Laparoscopic guided per oral video push enteroscopy.
7115 A MULTIDISCIPLINARY OVERVIEW OF COLITIS. Paul Nolan Yakshe, Tim Rubin, Jose Jessurun, Stephen Trenkner, Kathy Rozman-Holt, Univ of Minnesota, Minneapolis, MN; Fairview Univ Med Ctr, Minneapolis, MN. Inflammation of the colon can be caused by a variety of diseases. While the clinical presentation may suggest colitis, further evaluation by radiology, endoscopy and surgical pathology is usually necessary to make a specific diagnosis. BACKGROUND: For the past nine years, the authors have participated in a weekly multidisciplinary digestive disease conference. To preserve the teaching value from these cases and to increase the number of people who benefit from these efforts, we have begun to compile this information into educational videotapes. METHODS: Clinical cases of colitis from 1990 to 1999 were reviewed. Characteristic features of the clinical presentation, radiology, colonoscopy and surgical pathology from various cases were selected. A detailed script was created and revised according to the ASGE guidelines. The illustrative case histories, radiographs, video sequences, histology and pertinent teaching points were then formatted to match the script and edited onto a videotape. RESULTS: Eight conditions are presented in a sequential, multidisciplinary fashion: the normal colon, ulcerative colitis, Crohn’s colitis, ischemic colitis, colonic mucosal prolapse syndrome, collagenous & lymphocytic colitis, acute hemorrhagic colitis and pseudomembranous colitis. CONCLUSION: This videotape reviews the charateristic features of several common forms of colitis in a multidisciplinary fashion.
7117 LAPAROSCOPIC GUIDED PER ORAL VIDEO PUSH ENTEROSCOPY. Paul Bauret, Jean Michel Fabre, Dominique Larrey, Hosp Saint Eloi, Montpellier, France. Video push enteroscopy is the most frequently used method for the small bowel endoscopic examination but it evaluates only the proximal jejunum and the distal ileum. Intraoperative enteroscopy allows total small intestine visualization but requires an open laparotomy with morbidity and sometimes mortality. The development of the laparoscopic surgery could allow a panenteroscopy with lower morbidity. Aim of the study: Evaluate feasibility and usefulness of laparoscopic guided per oral push enteroscopy. Patients and methods: The investigation requires 3 successive periods: an exploratory laparoscopy, a per oral enteroscopic (Olympus SIF 100) insertion without enterotomy, an enteroscopic progression with mucosal ans serosal examination, combinig push of the scope and bowel telescoping. The procedure was performed in 8 patients (6 with unexplained intestinal bleeding, 2 with intestinal colics). Results: 1) Laparoscopy showed a lesion in 5 patients (3 tumors on the distal jejunum or proximal ileum, 2 Meckel’s diverticula). 2) Enteroscopy was performed in 7 patients (1 aborted intubation in a case of Meckel’s diverticulum); it inspected the whole jejunum in 6 patients, the proximal ileum in 2 patients, the whole ileum in 1 patient; enteroscopy completed the laparoscopic examination in 3 patients (2 transmural lesions, 1 mesenteric tumor with no mucosal involvement) and found a proximal ileal angiodysplasia in 1 patient. 3) Laparoscopy and enteroscopy were normal in 2 patients. 4) Surgical resection was performed in 5 patients (2 conversions to open laparotomy); there were no complications. Conclusion: Laparoscopic guided per oral enteroscopy combines exploratory laparoscopy and enteroscopy without enterotomy ; it visualizes about two thirds of the small bowel mucosal surface; it could avoid open laparotomy.
7116 UNSEDATED TRANS-NASAL GASTROSCOPY IN 1000 PATIENTS: FEASIBILITY, SAFETY, TOLERANCE AND COST-EFFECTIVENESS. Fausto Barberani, Sandro Boschetto, Virginia Festa, Maurizio Giovannone, Mauro Tosoni, Gastroenterology-S Camillo Hosp, Rieti, Italy. Background: Conventional gastroscopy (CG)is considered as a traumatic examination by the patients and expensive for National Health Care Service. Previous studies have demonstrated unsedated trans-nasal gastroscopy (TG) is feasible and well-tolerated. Aim: to compare the feasibility, safety, tolerance and cost-effectiveness of TG versus CG. Methods: Between September 1998 and June 1999,1000 patients (M/F ratio: 480/520; age range 12-95 years)were submitted to unsedated TG (Pentax fiberoptic endoscope FG-16V, 5 mm in diameter), half of them performed both CG at first examination and TG at follow-up. Oxygen saturation was measured during the procedure by Minolta-pulsox oxymeter. Patients’ tolerance (discomfort, nausea, vomiting, choking)was assessed on visual analogue scales. Direct and indirect costs were considered for cost-analysis. Results: Unsedated TG was feasible in 978 patients (97.8%), in 2.2 % the examination failed for anatomical reasons. Mean time taken for TG was 3 +/- 1 minutes. No complications were observed. Oxygen saturation did not change during TG. TG was more acceptable and less uncomfortable to the patients than CG, results are in the table. Cost-analysis showed that TG is three times less expensive than CG. Total amount of direct and indirect costs for the former is of Euro 85.96 versus Euro 220.61 for the latter. Conclusions: TG is feasible, safe and well tolerated by patients. Eighty-four percent of patients were willing to undergo unsedated TG in the future. Among patients submitted to both TG ang CG 90% would choose TG for further examinations. By reducing consumable and pharmaceutical costs, and eliminating the need for sedation -related work-loss and post-procedural monitoring, TG is more cost-effective than CG.
7118 IMMEDIATE EFFECTS OF PHOTODYNAMIC THERAPY ON DYSPLASTIC BARRETT’S EPITHELIUM AS MEASURED BY OPTICAL COHERENCE TOMOGRAPHY. Stephan A. Brand, Brett E. Bouma, Gary J. Tearney, John M. Poneros, Norman S. Nishioka, MA Gen Hosp, Harvard Med Sch, Boston, MA; MA Gen Hosp, Boston, MA. Background: Optical coherence tomography (OCT) is a new high resolution (10 µm) cross-sectional imaging technology which is analogous to ultrasound but uses infrared light rather than sound. Photodynamic therapy (PDT) is an ablative technique which is increasingly being used to treat dysplastic Barrett’s epithelium. No immediate tissue effect can be seen endoscopically making it impossible to predict tissue response. The aim of this study was to examine whether changes in esophageal tissue as visualized by OCT can be detected immediately following PDT. Methods: Five patients with Barrett’s esophagus and high-grade dysplasia (n = 4) or esophageal adenocarcinoma (n = 1) were treated with PDT. All patients received 2 mg/kg porfimer sodium 48 hours before PDT illumination. PDT was performed using a KTP laser pumped dye laser (λ = 630 nm) delivered through a cylindrical diffuser or a windowed balloon device to a total light dose of 150 J/cm. OCT images were obtained immediately before and after PDT using a prototype catheter based endoscopic OCT system. Image acquisition was performed using an optical fiber catheter coupled to the OCT system and passed through the endoscope instrument channel. Results: In all patients the OCT appearance changed immediately following PDT. OCT images taken prior to PDT showed the typical characteristics of dysplastic Barrett’s epithelium (i.e., inhomogenous contrast, mucosal glands). Immediately following PDT there was enhanced superficial mucosal contrast in the OCT images due to increased backscattering. The OCT image penetration depth was significantly (p<0.01) reduced following PDT (0.74±0.21 mm) compared to images obtained prior to PDT (1.18±0.16 mm) due to this increased backscattering from the superficial mucosa. Conclusion: PDT immediately influences the optical properties of tissue as reflected in the OCT appearance. OCT may be a method to immediately monitor the extent of PDT-treated mucosa after PDT before mucosal changes are visible by white light endoscopy. OCT may aid in detecting insufficiently treated areas during PDT.
Analogue visual scale (0-10)
TG
0-3 >3 total
435* 55 490
CG 50 440 490
total 485 495 980
* p=<0.05
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB271
7117 LAPAROSCOPIC GUIDED PER ORAL VIDEO PUSH ENTEROSCOPY. Paul Bauret, Jean Michel Fabre, Dominique Larrey, Hosp Saint Eloi, Montpellier, France. Video push enteroscopy is the most frequently used method for the small bowel endoscopic examination but it evaluates only the proximal jejunum and the distal ileum. Intraoperative enteroscopy allows total small intestine visualization but requires an open laparotomy with morbidity and sometimes mortality. The development of the laparoscopic surgery could allow a panenteroscopy with lower morbidity. Aim of the study: Evaluate feasibility and usefulness of laparoscopic guided per oral push enteroscopy. Patients and methods: The investigation requires 3 successive periods: an exploratory laparoscopy, a per oral enteroscopic (Olympus SIF 100) insertion without enterotomy, an enteroscopic progression with mucosal ans serosal examination, combinig push of the scope and bowel telescoping. The procedure was performed in 8 patients (6 with unexplained intestinal bleeding, 2 with intestinal colics). Results: 1) Laparoscopy showed a lesion in 5 patients (3 tumors on the distal jejunum or proximal ileum, 2 Meckel’s diverticula). 2) Enteroscopy was performed in 7 patients (1 aborted intubation in a case of Meckel’s diverticulum); it inspected the whole jejunum in 6 patients, the proximal ileum in 2 patients, the whole ileum in 1 patient; enteroscopy completed the laparoscopic examination in 3 patients (2 transmural lesions, 1 mesenteric tumor with no mucosal involvement) and found a proximal ileal angiodysplasia in 1 patient. 3) Laparoscopy and enteroscopy were normal in 2 patients. 4) Surgical resection was performed in 5 patients (2 conversions to open laparotomy); there were no complications. Conclusion: Laparoscopic guided per oral enteroscopy combines exploratory laparoscopy and enteroscopy without enterotomy ; it visualizes about two thirds of the small bowel mucosal surface; it could avoid open laparotomy.
7116 UNSEDATED TRANS-NASAL GASTROSCOPY IN 1000 PATIENTS: FEASIBILITY, SAFETY, TOLERANCE AND COST-EFFECTIVENESS. Fausto Barberani, Sandro Boschetto, Virginia Festa, Maurizio Giovannone, Mauro Tosoni, Gastroenterology-S Camillo Hosp, Rieti, Italy. Background: Conventional gastroscopy (CG)is considered as a traumatic examination by the patients and expensive for National Health Care Service. Previous studies have demonstrated unsedated trans-nasal gastroscopy (TG) is feasible and well-tolerated. Aim: to compare the feasibility, safety, tolerance and cost-effectiveness of TG versus CG. Methods: Between September 1998 and June 1999,1000 patients (M/F ratio: 480/520; age range 12-95 years)were submitted to unsedated TG (Pentax fiberoptic endoscope FG-16V, 5 mm in diameter), half of them performed both CG at first examination and TG at follow-up. Oxygen saturation was measured during the procedure by Minolta-pulsox oxymeter. Patients’ tolerance (discomfort, nausea, vomiting, choking)was assessed on visual analogue scales. Direct and indirect costs were considered for cost-analysis. Results: Unsedated TG was feasible in 978 patients (97.8%), in 2.2 % the examination failed for anatomical reasons. Mean time taken for TG was 3 +/- 1 minutes. No complications were observed. Oxygen saturation did not change during TG. TG was more acceptable and less uncomfortable to the patients than CG, results are in the table. Cost-analysis showed that TG is three times less expensive than CG. Total amount of direct and indirect costs for the former is of Euro 85.96 versus Euro 220.61 for the latter. Conclusions: TG is feasible, safe and well tolerated by patients. Eighty-four percent of patients were willing to undergo unsedated TG in the future. Among patients submitted to both TG ang CG 90% would choose TG for further examinations. By reducing consumable and pharmaceutical costs, and eliminating the need for sedation -related work-loss and post-procedural monitoring, TG is more cost-effective than CG.
7118 IMMEDIATE EFFECTS OF PHOTODYNAMIC THERAPY ON DYSPLASTIC BARRETT’S EPITHELIUM AS MEASURED BY OPTICAL COHERENCE TOMOGRAPHY. Stephan A. Brand, Brett E. Bouma, Gary J. Tearney, John M. Poneros, Norman S. Nishioka, MA Gen Hosp, Harvard Med Sch, Boston, MA; MA Gen Hosp, Boston, MA. Background: Optical coherence tomography (OCT) is a new high resolution (10 µm) cross-sectional imaging technology which is analogous to ultrasound but uses infrared light rather than sound. Photodynamic therapy (PDT) is an ablative technique which is increasingly being used to treat dysplastic Barrett’s epithelium. No immediate tissue effect can be seen endoscopically making it impossible to predict tissue response. The aim of this study was to examine whether changes in esophageal tissue as visualized by OCT can be detected immediately following PDT. Methods: Five patients with Barrett’s esophagus and high-grade dysplasia (n = 4) or esophageal adenocarcinoma (n = 1) were treated with PDT. All patients received 2 mg/kg porfimer sodium 48 hours before PDT illumination. PDT was performed using a KTP laser pumped dye laser (λ = 630 nm) delivered through a cylindrical diffuser or a windowed balloon device to a total light dose of 150 J/cm. OCT images were obtained immediately before and after PDT using a prototype catheter based endoscopic OCT system. Image acquisition was performed using an optical fiber catheter coupled to the OCT system and passed through the endoscope instrument channel. Results: In all patients the OCT appearance changed immediately following PDT. OCT images taken prior to PDT showed the typical characteristics of dysplastic Barrett’s epithelium (i.e., inhomogenous contrast, mucosal glands). Immediately following PDT there was enhanced superficial mucosal contrast in the OCT images due to increased backscattering. The OCT image penetration depth was significantly (p<0.01) reduced following PDT (0.74±0.21 mm) compared to images obtained prior to PDT (1.18±0.16 mm) due to this increased backscattering from the superficial mucosa. Conclusion: PDT immediately influences the optical properties of tissue as reflected in the OCT appearance. OCT may be a method to immediately monitor the extent of PDT-treated mucosa after PDT before mucosal changes are visible by white light endoscopy. OCT may aid in detecting insufficiently treated areas during PDT.
Analogue visual scale (0-10)
TG
0-3 >3 total
435* 55 490
CG 50 440 490
total 485 495 980
* p=<0.05
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB271