Wireless capsule endoscopy compared to combined push-enteroscopy with enteroclysis x-ray examination of the small bowel

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Abstracts

846 WIRELESS CAPSULE ENDOSCOPY COMPARED TO COMBINED PUSH-ENTEROSCOPY WITH ENTEROCLYSIS XRAY EXAMINATION OF THE SMALL BOWEL Reynaldo Rodriguez, D.O., Jack A. DiPalma, M.D., FACG* University of South Alabama, Mobile, AL. Purpose: To evaluate the findings of wireless capsule endoscopy compared to combined push enteroscopy and enteroclysis small bowel x-rays. The combined procedure utilizes an endoscopically-placed guidewire to facilitate placement of the duodenal occlusive balloon for enteroclysis x-ray. Methods: The study group consisted of patients undergoing small bowel examination for obscure gastrointestinal bleeding and iron deficient anemia. Wireless capsule endoscopy was performed using the Given Imaging System (Given Imaging Ltd., Yoqneam, Israel). Push enteroscopy was performed using a dedicated Olympus enteroscope and conscious sedation. After completing the endoscopic examination, a 450cm long, 0.64mm diameter guidewire (Jag Wire, Boston Scientific Company/Microvasive, Watertown, MA, USA) was placed. The guidewire was used to position a 13 French, 155cm long enteroclysis occlusive balloon catheter (Maglinte Enteroclysis Balloon catheter, A Cook Group Company, Bloomington, IN, USA). Enteroclysis was performed using double-contrast techniques (Entrobar Barium Sulfate Suspension 50% w/v and Entrocel methyl cellulose solution, Lafayette Pharmaceuticals, Lafayette, IN, USA). Data were examined for technical success, endoscopic and radiologic findings and acceptability of the studies for diagnostic purposes. Results: Nine consecutive subjects were analyzed. There were 6 men and 3 women. Mean age was 62.3 years. Enteroscopy showed small bowel abnormailities in 4/9 study subjects with small bowel erosions (1) and arteriovenous malformations (AVMs) (3). One enterolclysis subject has an unsuccessful catheter placement. Enteroclysis was abnormal in 2/8 with jejunal diverticulum (1) and mucosal irregularity (1). Wireless endoscopy was abnormal in 8/9 with polyps (3), AVMs (7). There were no complications from either procedure. Conclusions: Compared to combined same day enteroscopy and enteroclysis, wireless capsule endoscopy was more likely to reveal significant clinical findings

847 PERCEIVED UTILITY AND AVAILABILITY OF ENDOSCOPIC ULTRASONOGRAPHY IN THE STAGING OF ESOPHAGEAL CANCERS: A NATIONAL SURVEY OF GASTROENTEROLOGISTS Judd Adelman, M.D., Jonathan White, M.D., Anthony Infantolino, M.D., Robert Coben, M.D., Leo Katz, M.D., Sidney Cohen, M.D., Anthony DiMarino, M.D.* Thomas Jefferson University Hospital, Philadelphia, PA. Purpose: Although endoscopic ultrasonography (EUS) is well recognized as a valuable tool for staging esophageal cancer, its utilization in practice is inconsistent. The purpose of this study is to evaluate the perceived value of EUS in staging esophageal cancer and to determine the actual utilization of EUS. Methods: A questionnaire was mailed to 2350 gastroenterologists who identified themselves as clinical practitioners. A total of 874 completed surveys were returned, yielding a response rate of 37%. Responses from retired physicians, physicians practicing pediatric gastroenterology, and those not in clinical practice were eliminated. A total of 644 completed surveys were included in the analysis. Results: Of the 644 respondents, 180 (28%) report that they perform EUS for staging of esophageal cancers within their own practice setting, and 464 (72%) report that they do not. Of these 464 respondents, 275 refer their patients elsewhere and 189 report that they neither perform EUS within their own practice setting, nor refer their patients elsewhere. Among community-based practitioners, 15.5% perform EUS within their own practice setting and 84.4% do not. Among university-based gastroenterol-

AJG – Vol. 98, No. 9, Suppl., 2003

ogists, 81.1% report that they perform EUS within their own practice setting and 18.9% do not. Respondents who reported that they did not perform EUS within their own practice setting and who also tended not to refer their patients for EUS staging of esophageal cancer rated a series of statements on their attitudes toward this modality. A majority of respondents believe that they lack sufficient training in the procedure, indicate that the high price of equipment makes this procedure too expensive, and agree that EUS is too time-consuming relative to its reimbursement. A minority feel that EUS is not geographically available. Conclusions: (A) EUS is overall underutilized in staging of esophageal cancer, but less so in academic health centers; (B) Many clinicians still do not fully recognize the value of staging by EUS; (C) EUS remains a relatively new skill that has not been acquired in many community settings. This study suggests that EUS training and education requires greater emphasis and attention in U.S. training programs. 848 OPTIMAL MIDAZOLAM DOSE, FACTORS AFFECTING MIDAZOLAM DOSE AND PROPER TIMING OF FLUMAZENIL INJECTION DURING ESOPHAGOGASTRODUODENOSCOPY Jung Yul Suh, M.D., Chong Il Sohn, M.D.*, In Kyung Sung, M.D., Woo Kyu Jeon, M.D., Byung Ik Kim, M.D. Sungkyunkwan University School of Medicine, Seoul, Pyung-Dong, Republic of Korea. Purpose: The purposes of this study were to determine the proper doses of midazolam for esophagogastroduonenoscopy and factors which affect midazolam doses. Also we evaluated the proper timing of flumazenil injection to increase patient’s satisfaction according to sedation status. Methods: One hundred and twenty-six patients who were supposed to be taken diagnostic esophagogastro- duonenoscopic exam were enrolled in this study. We evaluated the difference of patient’s age, sex, alcohol consumption, sedation score, cooperation score, and satisfaction score according to midazolam doses. The relation between midazolam doses and agitation score, insomnia score, and somatic preoccupation score were checked. We evaluated the relation between midazolam doses and age, sex, alcohol consumption, amnesia, sedation, cooperation and satisfaction. Results: There were no relationship between age, sex and midazolam doses. Alcoholics needed larger amount of midazolam than non-alcoholics. No differences in satisfaction were observed according to sedation status. There were significant relationship between midazolam doses and sedation score but not with satisfaction, cooperation, agitation, insomnia and somatic preoccupation score. Patients who were injected flumazenil 20 minutes after esophagogastroduonenoscopy were more satisfied than patients who were injected flumazenil immediately after esophagogastroduonenoscopy. Conclusions: Minimal doses of midazolam that could induce mild sedation was enough and safe. Flumazenil injection 20 minutes after esophagogastroduonenoscopy was more efficacious than immediate injection. 849 IS THE VARIABLE STIFFNESS PEDIATRIC COLONOSCOPE MORE EFFECTIVE THAT A STANDARD ADULT COLONOSCOPE FOR OUTPATIENT ADULT COLONOSCOPY? A RANDOMIZED CONTROLLED TRIAL Samer H. Al-Shurieki, M.D., Priya Ravindran, M.D., John B. Marshall, M.D.* University of Missouri Hospital and Clinics, Columbia, MO. Purpose: Variable stiffness pediatric colonoscopes (VSPC) have been increasingly popular since their introduction. There are few studies comparing the efficacy of the VSPC to a standard adult colonoscope (AC). Our aim was to compare the use of a VSPC with an AC with respect to efficacy and patient tolerance, using one expert endoscopist to perform all procedures. Methods: One hundred and sixty-eight consecutive adult outpatients presenting for colonoscopy were randomized to either a VSPC (Olympus