- Email: [email protected]
T1412: Newly Developed a Training Model for Balloon Endoscopy
Abstracts 200 procedures.Female patients and advanced age(over 60 years) were associated with prolonged cecal intubation time(⬎20 minutes). Surgery of the uterus and ovaries were significantly correlated with delayed cecal intubation time, but not after sufficient colonoscopy experience.Conclusions:The minimum number of procedures to reach technical competence was 200. The cecal intubation time was prolonged by female gender and advanced age. Factors affecting the success rate within 20 minutes by multivariate analysis Affecting factors Age ⬍60 y ⱖ60 y Sex Male Female BMI ⬍25 ⱖ25 Previous operation Stomach Hepatobiliary Appendectomy Cessarian section Uterus & ovary ⬍200⫹ ⱖ200⫹
Success rate(%)
Odds ratio
95% CI
P-value
1.421
1.122-1.785
0.01
1.889
1.241-2.326
0.004
0.837
0.723-0.947
0.813
81.1 82.1 78.4 77.2
1.171 1.302 1.081 1.296
0.871-1.249 0.914-1.518 0.870-1.104 0.983-1.431
0.56 0.52 0.53 0.14
64.5 70.6
0.840 0.985
0.803-0.948 0.781-1.592
0.031 0.36
83.2 77.8 83.9 77.6 79.8 80.3
⫹: Number of colonoscopies. Bold figures indicate statistical significance
T1410 Evaluation of Colon Preparation Methods Prior to a Colonoscopy: A Prospective, Randomized, Comparative Study Among a Low Volume Polyethylene Glycol Plus Bisacodyl Solution and a Mannitol Plus Bisacodyl Solution Manoel C. Vieira, Luana V. Borges, Vivian M. Ussui, Jose Guilherme Nogueira Silva, Flair J. Carrilho, Claudio L. Hashimoto Background: Colonoscopy is currently the gold standard method to examine the colon, the rectum and the terminal ileum. In order to perform the colonoscopy, it is necessary to clean the bowel and use medications that are generally poorly tolerated by the patientsObjective: Compare the effectiveness, tolerability, acceptability and safety between two methods used for intestinal preparation in colonoscopy examination in BrazilDesign: Prospective randomized double blind studySettings: Single-Center outpatient ambulatory endoscopy unitMethods: One hundred patients were randomized into two groups paired based on sex and age. Group I received bisacodyl plus 1 liter of polyethylene glycol (PEG) the night before and 1 liter on the day of the exam. Group II received bisacodyl the night before and 1 liter of a 10% mannitol solution on the day of the exam. The patients’ diets were the same for both groups. The quality of the preparation was graded based on the Boston and Ottawa scales. Tolerability and acceptability were measured using previously validated questionnaires. Safety was evaluated as variations in vital signs before and after the preparation, as well as any other complication.Main Outcome Measurements: Best effective, tolerated, acceptable and safety methods prior to colonoscopy Results: Ninety-six patients (96%) completed the study. No difference was observed in the quality of the preparation between both methods (p⫽ 0.059). As for tolerability, group II (Mannitol method) showed significantly higher frequency of nausea, vomiting, abdominal pain and abdominal distension (p⬍0.05). Acceptability was significantly better in group I (PEG method) (p ⬍ 0.05). The PEG method was also shown to be safer and no severe complication was observed (colon explosion).Conclusions: Based on the present study, the following conclusions can be made: 1) both methods of preparation had similar efficiencies (p⬎0.05); 2) PEG method showed higher tolerability, acceptability and safety compared to the mannitol method (p⬍0.05).
AB270 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
T1411 Diagnosis and Evaluation of Therapeutic Effect for Follicular Lymphoma With Small Bowel Involvement by Using Video Capsule Endoscopy and Double-Balloon Enteroscopy Masanao Nakamura, Naoki Ohmiya, Hiroyuki Takenaka, Kenji Morishima, Makoto Ishihara, Ryoji Miyahara, Takafumi Ando, Osamu Watanabe, Hiroki Kawashima, Akihiro Itoh, Yoshiki Hirooka, Hidemi Goto Background and Study Aims: Recently the usefulness of diagnosis for follicular lymphoma with small bowel involvement (FL) by using video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) has been reported. Chemotherapy including rituximab (R) has evolved and we often treat with R alone for FL of early stage. Endoscopic evaluation of chemotherapeutic effect during follow-up has not been well documented. In the present study, we aim to determine the role of VCE and DBE for the diagnosis of FL before and after treatment. Subjects and Methods: Of 150 consecutive patients with small bowel tumors/polyps who underwent DBE, 20 were diagnosed definitely as FL by surgical or biopsy specimens. For the enteroscopic evaluation, all 20 patients underwent CT and DBE, and 15 without obstructive symptoms underwent VCE. According to Lugano classification, 15, 3 and 2 patients were in stages I, II and IV, respectively. Biopsies by DBE in duodenum and jejunum were positive with all the patients, but those in ileum were positive in 15 patients. Regarding the treatment, the 14 patients in stage I were treated by R alone. One patient in stage I and four in stage II or more were treated by R, cyclophosphamide, hydroxydaunomycin, oncovin and prednisone (R-CHOP). Treatment of one patient with bulky mass in stage II included surgical resection followed by chemotherapy using R-CHOP. Results: Both VCE and DBE showed small lymphomatous polypoid lesions with white surface mainly in stage I. In addition, the swollen folds and stenosis were observed by DBE in patients with stages II and IV. Diagnostic yields of DBE-directed biopsy and VCE were 20/20(100%) and 15/15(100%), respectively. The effect of rituximab against FL in stage I was evaluated for six patients at VCE and DBE as follows; partial remission was 2/6 (33%), complete remission was 3/6 (50%) and the effective rate was 83%. The result of the biopsy in duodenum by gastroscopy was negative in four of six patients, and three patients in them had complete remission, including whole small bowel. About another one of four patients, at the following DBE, the polypoid lesions with not white but normal color surface were seen in the ileum, suggesting the reactive lymphoid hyperplasia. However, one biopsy specimen from them was positive for FL. Conclusions: VCE was effective for the evaluation of partial remission, but may not be adopted for that of complete remission. DBE-directed biospy was effective for the confirmation of complete remission.
T1412 Newly Developed a Training Model for Balloon Endoscopy Yutaka Endo, Toshihiro Nakano, Hiroshi Takahashi Introduction: The balloon endoscopes (BE) had changed the diagnosis and treatment for small intestinal disease. Although the BE insertion skill is not high, the balloon control and insertion technique is difficult for beginners and the training methods for BE is not established. The hands-on training is the widely performing method. However, the experience is limited because the BE cases are small in number comparing to colonoscopies. To resolve theses problem, we had newly developed a BE training model in collaboration with Koken Company (Tokyo, Japan).Developed model: The training model is consists of colon and 1.5m small intestine made of silicon rubber. The colon part is the similar to the colon model which is distributed by Koken Company. To simulate the small intestinal shortening by pull the scope, the intestine is loosely attached to the abdominal cavity case by rubber band. And the sheet is located to restrict to move within pelvic cavity. The difficulty of insertion could be changed by altering the pelvic intestinal volume and bending. The prototype of this model was made for double balloon endoscope. To adapt to single balloon endoscope, the silicon rubber processing had altered. The movement of the intestine can be seen through the transparent abdominal cavity sheet. Silicon spray is used as a lubricant.Result: The initial training impression was well simulated the BE insertion. Especially, the pass through the ileo-cecal valve is the most difficult part of trans-anal insertion was well imitated. The shortening intestinal movement by single and double BE was smooth and real.Conclusion: The BE training model is useful to understand the BE insertion theory, how to use the balloon controller and training the BE insertion technique.
T1413 Increased Levels of Job-Related Stress and Burnout in Interventional Gastroenterologists (IGEs): Findings From a U.S. Survey Tiffany H. Taft, Laurie Keefer, Gregory A. Cote, Rajesh N. Keswani ⬍p⬎Introduction: Physician stress and burnout are widely studied phenomenon. Burnout can lead to decreased job satisfaction, increased medical errors, and
www.giejournal.org
Success rate(%)
Odds ratio
95% CI
P-value
1.421
1.122-1.785
0.01
1.889
1.241-2.326
0.004
0.837
0.723-0.947
0.813
81.1 82.1 78.4 77.2
1.171 1.302 1.081 1.296
0.871-1.249 0.914-1.518 0.870-1.104 0.983-1.431
0.56 0.52 0.53 0.14
64.5 70.6
0.840 0.985
0.803-0.948 0.781-1.592
0.031 0.36
83.2 77.8 83.9 77.6 79.8 80.3
⫹: Number of colonoscopies. Bold figures indicate statistical significance
T1410 Evaluation of Colon Preparation Methods Prior to a Colonoscopy: A Prospective, Randomized, Comparative Study Among a Low Volume Polyethylene Glycol Plus Bisacodyl Solution and a Mannitol Plus Bisacodyl Solution Manoel C. Vieira, Luana V. Borges, Vivian M. Ussui, Jose Guilherme Nogueira Silva, Flair J. Carrilho, Claudio L. Hashimoto Background: Colonoscopy is currently the gold standard method to examine the colon, the rectum and the terminal ileum. In order to perform the colonoscopy, it is necessary to clean the bowel and use medications that are generally poorly tolerated by the patientsObjective: Compare the effectiveness, tolerability, acceptability and safety between two methods used for intestinal preparation in colonoscopy examination in BrazilDesign: Prospective randomized double blind studySettings: Single-Center outpatient ambulatory endoscopy unitMethods: One hundred patients were randomized into two groups paired based on sex and age. Group I received bisacodyl plus 1 liter of polyethylene glycol (PEG) the night before and 1 liter on the day of the exam. Group II received bisacodyl the night before and 1 liter of a 10% mannitol solution on the day of the exam. The patients’ diets were the same for both groups. The quality of the preparation was graded based on the Boston and Ottawa scales. Tolerability and acceptability were measured using previously validated questionnaires. Safety was evaluated as variations in vital signs before and after the preparation, as well as any other complication.Main Outcome Measurements: Best effective, tolerated, acceptable and safety methods prior to colonoscopy Results: Ninety-six patients (96%) completed the study. No difference was observed in the quality of the preparation between both methods (p⫽ 0.059). As for tolerability, group II (Mannitol method) showed significantly higher frequency of nausea, vomiting, abdominal pain and abdominal distension (p⬍0.05). Acceptability was significantly better in group I (PEG method) (p ⬍ 0.05). The PEG method was also shown to be safer and no severe complication was observed (colon explosion).Conclusions: Based on the present study, the following conclusions can be made: 1) both methods of preparation had similar efficiencies (p⬎0.05); 2) PEG method showed higher tolerability, acceptability and safety compared to the mannitol method (p⬍0.05).
AB270 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
T1411 Diagnosis and Evaluation of Therapeutic Effect for Follicular Lymphoma With Small Bowel Involvement by Using Video Capsule Endoscopy and Double-Balloon Enteroscopy Masanao Nakamura, Naoki Ohmiya, Hiroyuki Takenaka, Kenji Morishima, Makoto Ishihara, Ryoji Miyahara, Takafumi Ando, Osamu Watanabe, Hiroki Kawashima, Akihiro Itoh, Yoshiki Hirooka, Hidemi Goto Background and Study Aims: Recently the usefulness of diagnosis for follicular lymphoma with small bowel involvement (FL) by using video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) has been reported. Chemotherapy including rituximab (R) has evolved and we often treat with R alone for FL of early stage. Endoscopic evaluation of chemotherapeutic effect during follow-up has not been well documented. In the present study, we aim to determine the role of VCE and DBE for the diagnosis of FL before and after treatment. Subjects and Methods: Of 150 consecutive patients with small bowel tumors/polyps who underwent DBE, 20 were diagnosed definitely as FL by surgical or biopsy specimens. For the enteroscopic evaluation, all 20 patients underwent CT and DBE, and 15 without obstructive symptoms underwent VCE. According to Lugano classification, 15, 3 and 2 patients were in stages I, II and IV, respectively. Biopsies by DBE in duodenum and jejunum were positive with all the patients, but those in ileum were positive in 15 patients. Regarding the treatment, the 14 patients in stage I were treated by R alone. One patient in stage I and four in stage II or more were treated by R, cyclophosphamide, hydroxydaunomycin, oncovin and prednisone (R-CHOP). Treatment of one patient with bulky mass in stage II included surgical resection followed by chemotherapy using R-CHOP. Results: Both VCE and DBE showed small lymphomatous polypoid lesions with white surface mainly in stage I. In addition, the swollen folds and stenosis were observed by DBE in patients with stages II and IV. Diagnostic yields of DBE-directed biopsy and VCE were 20/20(100%) and 15/15(100%), respectively. The effect of rituximab against FL in stage I was evaluated for six patients at VCE and DBE as follows; partial remission was 2/6 (33%), complete remission was 3/6 (50%) and the effective rate was 83%. The result of the biopsy in duodenum by gastroscopy was negative in four of six patients, and three patients in them had complete remission, including whole small bowel. About another one of four patients, at the following DBE, the polypoid lesions with not white but normal color surface were seen in the ileum, suggesting the reactive lymphoid hyperplasia. However, one biopsy specimen from them was positive for FL. Conclusions: VCE was effective for the evaluation of partial remission, but may not be adopted for that of complete remission. DBE-directed biospy was effective for the confirmation of complete remission.
T1412 Newly Developed a Training Model for Balloon Endoscopy Yutaka Endo, Toshihiro Nakano, Hiroshi Takahashi Introduction: The balloon endoscopes (BE) had changed the diagnosis and treatment for small intestinal disease. Although the BE insertion skill is not high, the balloon control and insertion technique is difficult for beginners and the training methods for BE is not established. The hands-on training is the widely performing method. However, the experience is limited because the BE cases are small in number comparing to colonoscopies. To resolve theses problem, we had newly developed a BE training model in collaboration with Koken Company (Tokyo, Japan).Developed model: The training model is consists of colon and 1.5m small intestine made of silicon rubber. The colon part is the similar to the colon model which is distributed by Koken Company. To simulate the small intestinal shortening by pull the scope, the intestine is loosely attached to the abdominal cavity case by rubber band. And the sheet is located to restrict to move within pelvic cavity. The difficulty of insertion could be changed by altering the pelvic intestinal volume and bending. The prototype of this model was made for double balloon endoscope. To adapt to single balloon endoscope, the silicon rubber processing had altered. The movement of the intestine can be seen through the transparent abdominal cavity sheet. Silicon spray is used as a lubricant.Result: The initial training impression was well simulated the BE insertion. Especially, the pass through the ileo-cecal valve is the most difficult part of trans-anal insertion was well imitated. The shortening intestinal movement by single and double BE was smooth and real.Conclusion: The BE training model is useful to understand the BE insertion theory, how to use the balloon controller and training the BE insertion technique.
T1413 Increased Levels of Job-Related Stress and Burnout in Interventional Gastroenterologists (IGEs): Findings From a U.S. Survey Tiffany H. Taft, Laurie Keefer, Gregory A. Cote, Rajesh N. Keswani ⬍p⬎Introduction: Physician stress and burnout are widely studied phenomenon. Burnout can lead to decreased job satisfaction, increased medical errors, and
www.giejournal.org