Development of One Man Method for Double Balloon Endoscopy

Abstracts

S1380 Development of One Man Method for Double Balloon Endoscopy Akihiro Araki, Kiichiro Tuchiya, Shigeru Oshima, Eriko Okada, Sanae Yoshioka, Shinji Suzuki, Daisuke Kubota, Takanori Kanai, Mamoru Watanabe Background: Double Balloon Endoscopy (DBE) is a newly developed device that has the capability to examine total small intestine on a clinical level. However, a standard method of DBE requires two persons, operator and assistant, to perform it at this time. Aims: To improve this manpower problem in keeping safety, we here develop a modified ‘One-Man Method’ for DBE. Methods: In standard DBE method, an assistant constantly keeps the over tube, while an operator handles a DBE endoscope. In our ‘One-Man-Method’, however, we perform these two movements only by the right hand of an operator. Operator catch an end of an over tube by a thumb and a forefinger, and grip an endoscope with a little finger and the third finger and a palm. This right hand of operater insert endoscope to an over tube. An operator’s left hand pulls back endoscope and operation angle dial. A tool for specific assistance does not require it. We experienced 215 times of DBE in this institution until Novemberr 2006 from September 2004. A one man method practiced partly from November 2004 and introduced it and we shifted to all cases one man method now and performed 157 times. Results: The average insertion observation time was one man method upper part 95.5 minutes, lower 103 minutes and two man method upper part 96.7 minutes, lower 111 minutes(Table 1, 2). That the all small intestine observation rate was two man method 57.4%, one man method 56.8%. Insertion observation time, all small intestine observation rate did not accept significant difference between one man method / two man methods together. There is no significant difference in insertion observation time and all small intestine observation rate between a conventional method and a one man method. Conclusions: A one man method of DBE was possible and, it is thought that it is very useful both for personnal reduction and operability improvement without requiring particular devices.

31%, respectively. Students overestimated the diameter by 26%. With the help of the calibrator device the students underestimated the diameter by 15%. Physicians underestimated the diameter by 21% whereas experts still underestimated the diameters by 35%. The inter-individual log-scale standard deviation of the estimated diameter from the true diameter decreased during training in all groups, while intra-individual standard deviations decreased in students and increased in experts. Conclusions: Physicians tend to underestimate the size of small bowel lesions in WCE. The calibrating device helped only students to significantly improve in trueness of size estimation. All volunteers (students, doctors and experts in WCE) aggreed better when a calibrating device is offered.

Table 1. The average insertion observation time Two man method One man method

Upper part

Lower part

96.7 min. 95.5 min.

111 min. 103 min.

Table 2. The all small intestine observation rate Two man method One man method

57.4% 56.8%

S1381 Accuracy of Size Estimation in Wireless Capsule Endoscopy Florian Graepler, Manuel Wolter, Reinhard Vonthein, Michael Gregor Background and study aims: The accuracy of size estimation in wireless capsule endoscopy (WCE) has not been investigated so far. Exact knowledge of the size of small bowel lesions in WCE could help in the development of therapeutic strategies. The aim of the study was to describe the trueness and precision of size estimation in WCE and to develop a simple device which facilitates learning of exact size estimation in WCE. Methods: We recorded video sequences with a PillCamÒ wireless endoscope in a porcine small bowel model after implantation of ‘‘lesions’’ measuring two to ten mm in diameter. Volunteers were asked to estimate the diameter of these ‘‘lesions’’ without and with use of a calibrator device which was a reference picture from a black and white grid taken with the PillCamÒ in direct contact to the transparent dome. 75 medical students were compared with 21 physicians not performing and 21 experts actively performing WCE. Results: Physicians and experts underestimated the diameter of lesions by 32% and

S1382 Does Endoscopic Ultrasound’s Technology Affect the Nodal Staging of Gastric Cancers? A Meta-Analysis & Systematic Review Jyotsna B.K. Reddy, Srinivas R. Puli, Daphne Antillon, Jamal A. Ibdah, Mainor R. Antillon Purpose: Endoscopic ultrasounds (EUS) technology has changed over years and so has the criteria to diagnose nodal metastasis in patients with gastric cancers. The impact of technologic advancement of EUS on the accuracy to diagnose nodal staging is not known. Aim: To evaluate the impact of technologic advancements of EUS on the accuracy of N staging of gastric cancers. Methods: Study Selection Criteria: Only EUS studies confirmed by surgery or prolonged follow-up were selected. EUS criteria for nodal metastasis were: O1 cm, hypoechoic, and round instead of elliptical. Only studies from which a 2  2 table could be constructed were included. Data collection & extraction: Articles were searched in Medline, Pubmed, Ovid journals, CINH, and Cochrane control trial registry. 2  2 tables were constructed from the extracted data. Statistical Method: The EUS studies were grouped into 3 periods to standardize the change in EUS technology and also to standardize the change in EUS criteria for lymph node involvement. These time periods were 1986 to 1994, 1995 to 1999, and 2000 to 2006. Meta-analysis for the accuracy of EUS was found by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both MantelHaenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. Results: Initial search identified 3986 reference articles, of which 369 relevant articles were selected and reviewed. Data was extracted from 18 studies (N Z 1039) which met the inclusion criteria. All the pooled estimates during the three time periods are given in table 1. The p for chisquared heterogeneity for all the pooled accuracy estimates was O0.05. Conclusion: EUS is a good diagnostic tool to evaluate nodal metastasis in patients with gastric cancers. Over years the specificity remains very high. The sensitivity for advance disease (N2) is higher when compared to early disease. The sensitivity improved for early disease (N1) with improving technology. EUS should still be the test of choice to evaluate nodal metastasis as FNA can be performed during the procedure.

Table 1. Pooled diagnostic accuracy estimates of EUS for N staging during the time periods with 95% confidence intervals N1

Time period 1986 to 1994 1995 to 1999 2000 to 2006

No of studies 10 4 4

N2

Pooled sensitivity

Pooled specificity

Pooled positive likelihood ratio

56.3% (49-62.6) 64.6% (53.3-74.9) 67.5% (55.9-77.8)

89.1% (85.5-92.1) 83.5% (74.9-90.1) 85.1% (78.4-90.4)

4.6 (1.6-13.6) 3.6 (2.3-5.6) 4.5 (2.7-7.4)

Pooled negative likelihood ratio

Pooled diagnostic odds ratio

Pooled sensitivity

Pooled specificity

Pooled positive likelihood ratio

Pooled negative likelihood ratio

Pooled diagnostic odds ratio

0.5 (0.4-0.7) 0.5 (0.4-0.6) 0.4 (0.3-0.6)

9.3 (2.9-30.1) 8.8 (4.3-18.1) 11.9 (4.8-29.8)

70.6% (65.4-75.5) 70.2% (59.9-79.2) 51.6% (409-62.3)

94.7% (91.7-96.8) 83.2% (74.1-90.1) 94.1% (88.3-97.6)

11.0 (4.6-26.6) 3.9 (2.5-6.1) 9.0 (1.0-80.0)

0.3 (0.2-0.4) 0.4 (0.3-0.5) 0.5 (0.4-0.8)

63.9 (30.9-132.3) 11.7 (5.6-24.1) 18.5 (2.2-158.2)

AB160 GASTROINTESTINAL ENDOSCOPY Volume 65, No. 5 : 2007

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