- Email: [email protected]
T1596: Predictors of Diagnostic Yield of Video Capsule Endoscopy in Southwest Ohio Veteran Population
Abstracts T1595 Three Dimensional Image Overlay Navigation Using Magnetic Endoscope Detection System for NOTES® and SILS Maki Sugimoto, Yoshinori Morita, Tsuyoshi Sanuki, Hiromu Kutsumi, Takeshi Azuma AIM: NOTES and SILS (Single incision laparoscopic surgery) are novel challenging minimally invasive endoscopic surgery. The first barrier of NOTES and SILS is unpredictable nature of scope and working devices, these forced situations may result in an incomplete or lengthy procedure within such narrow and dark endoscopic viewing. For overcome these limitations, we developed novel 3-D endoscopic navigation system using magnetic scope detection system. It was able to depict real-time position and movement of the endoscope threedimensionally in the abdominal cavity.METHOD: Under general anesthesia, we performed transgastric NOTES cholecystectomy, gastrojejunostomy, appendectomy in survived 10 porcine and canine experiments. By using a magnetic endoscope observation device, the shape and position of endoscopes (flexible endoscope in NOTES, and laparoscope in SILS) were reconstructed and projected on to the abdominal wall in real time throughout the examination. RESULT: Using a low intensity magnetic field, this 3-D Imager enabled to display a 3-D view of the endoscope on the abdominal wall, by means of electromagnetic transmission coils built into the endoscope. Shorter procedure time was acquired. All procedures were completed without complications. DISSCUSION:This magnetic endoscope navigation system was useful for physicians to see the location and shape of the scope from the outside during an endoscopic examination without the risk of x-ray exposure. Moreover we developed a new integrating navigation system that virtual 3D anatomy regenerated from MDCT data in DICOM image viewer OsiriX and 3D scope navigation could be superimposed in a monitor screen by detecting the distance between a scope position and skin surface using additional magnetic markers outside the body. It revealed accurate relations of the patient anatomy and scope orientationCONCLUSION:For development of the innovative surgical technology, the limitations in NOTES and SILS should be overcome using such navigation systems in the meaning of safety.
components of gastric electro-mechanical activity. Although novel endoscopic techniques have been developed for temporary stimulation requiring external wires, permanent GES requires surgical implantation of a large, battery-based neurostimulator device. We have developed two new miniature gastric stimulators, one with a wirelessly rechargeable battery and the other wirelesslypowered without a battery.Method: Both designs were manufactured on printed circuit boards with wrapped antennas and packaged in soft polymer supporting 2 wires for electrode connection. Each design provides three settings (Table 1) and has a size of 12mmx3.7mmx0.9mm. In the first design, a rechargeable battery drives a reprogrammable pulse generator, while a magnetic reed switch permits alternation between charging and stimulation. In the second design, required pulse trains are generated through charge pump circuitry and a microcontroller that harvests radio-frequency energy from an external antenna. An acute pig model was employed with approval from and following protocols by the Animal Control Board of the University of Mississippi Medical Center. A 40kg anesthetized pig was endoscopically implanted with the electrical stimulator, and using electrodes attached serosally and mucosally, EGG recordings was made in response to stimulations. Mucosal and serosal EGG recording were analyzed by signal averaging for mean frequency and amplitude, as well as their ratio (FAR).Results: Shown in Table 2, both miniaturized models for electrical stimulation delivery produced changes in EGG, especially in FAR.Conclusion: We have demonstrated the feasibility of two types of miniature gastric stimulators in animal tests with successful modulation of gastric electrical activities. These stimulators offer the possible applications to endoscopic implantation of wireless systems. Table 1: Setting in each design. Dose Low Medium High
Pulse frequency Pulse duty cycle Pulse “On” time Pulse “Off” time 14Hz 28Hz 55Hz
0.46% 0.92% 1.82%
0.1s 1.0s 4.0s
5.0s 4.0s 1.0s
Table 2: Measurement results. Electrical Current
T1596 Predictors of Diagnostic Yield of Video Capsule Endoscopy in Southwest Ohio Veteran Population Chike C. Anusionwu, Khurram Bari, Sangeeta Agrawal, Salma Akram Background: Video capsule endoscopy (VCE) is an effective, minimally invasive technique that has revolutionized the study of small bowel (SB) pathology. However, there is paucity of data on which clinical factors predict higher yield of VCE to detect SB pathology. Aim:To determine the diagnostic yield of VCE and its predictors in the veterans seen at Dayton Veterans Affairs Medical Center(VAMC).Methods:All patients who underwent VCE from June 2007- August 2009 at the Dayton VAMC were included in the study. Data on patient demographics, indication for procedure, clinical setting of procedure, medication use at time of procedure, co-morbidities and VCE findings was collected by retrospective chart review. Univariate analysis was used to determine if any clinical or demographic variables were associated with VCE findings in these patients.Results: A total of 136 patients (95% male, n⫽129),74% Caucasian (n⫽100) with median age of 63 years (interquartile range{IQR}, 56-75 years) were studied. The median follow-up was 9 months (IQR, 4-14 months). All patients had previously undergone esophagogastroduodenoscopy and colonoscopy with negative results. VCE was carried out in an inpatient setting in 37 patients (27%). The median hemoglobin at the time of VCE was 10.7g/dl (IQR, 8.5-11.9 g/dl). The indication for the procedure was iron deficiency anemia in 88 patients (65%), overt bleeding (OB) in 33 patients (24%) and others ( e.g suspected mass in SB (n⫽6), chronic abdominal pain (n⫽5), suspected Crohn’s disease(n⫽2) and chronic diarrhea(n⫽2) in 15 patients (11%). Positive findings were identified in 66 patients (49%). The commonest findings were non-bleeding arteriovenous malformations (AVM) (n⫽26,19%), followed by SB mucosal irregularity (n⫽20,15%), bleeding AVM(n⫽ 8, 6%), SB ulceration (n⫽7, 5%), and SB mass (n⫽5, 4%). Female sex (9.1% vs. 1.4%, p⫽0.06), increasing age (p⫽0.19), use of non-steroidal anti-inflammatory drugs/aspirin (53% vs. 40%,p⫽0.17 ) and the presence of liver disease (13.6% vs. 5.7%,p⫽0.15 ) were non-significantly more likely to predict a positive yield on VCE.Conclusions: In our study population, gender, increasing age of patients, use of NSAIDS/aspirin and the presence of liver disease more likely led to positive yield on VCE. The explanation for the above findings is not entirely clear. Larger scale studies are needed to confirm the value of these clinical factors in determining positive diagnostic yield.
T1597 Miniature Wireless Gastric Electrical Stimulators Sanchali Deb, Thomas L. Abell, Filip To, Danielle C. Spree, Christopher J. Lahr, Wen-Ding Huang, J. C. Chiao Introduction: Gastric electrical stimulation (GES), an accepted therapy for drug refractory gastroparesis, applies electrical stimulation to tissues to help control
AB318 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
EGG Signal Summary
Stimulator
Power source
Dose
Mucosa
Serosa
Mean Freq. (Hz)
Freq. Range (Hz)
Mean Amp. (V)
Amp. Range (V)
#1
Rechargeable
Low
3.45mA
1.7mA
3.5
3.0-4.0
0.20
0.200.21 0.150.20 0.150.20 N/A
#2
Rechargeable
Medium
3.63mA
1.93mA
3.08
3.0-3.3
0.17
#3
Rechargeable
High
3.63mA
1.93mA
3.75
3.5-4.0
0.14
#4
Batteryless
Low
5.00mA
2.26mA
N/A
N/A
N/A
#5
Batteryless
Medium
5.00mA
2.26mA
3.00
3.0-3.1
0.06
#6
Batteryless
High
5.00mA
2.26mA
3.83
3.0-5.0
0.1
0.060.07 0.080.13
FAR (Hz/V) 17.5 18.1
Note Serosal EGG recording
26.8 N/A
50 38.3
EGG was not recorded Mucosal EGG recording
T1598 Novel Approach to Refractory Fecal Impaction Using LargeVolume Wide-Caliber Irrigation With BioVac Snorri Olafsson, Zebayel B. Akele, Carl Robinson, Christian S. Jackson, Amy Strickland Introduction:Fecal impaction is a solid, immobile bulk of stool. If traditional therapy with laxatives, manual fragmentation, enemas, sigmoidoscopy, and polyethylene glycol fail, surgery may be required. BioVac (BV) was developed to improve visibility in GI bleeding. We successfully used it off-label for resistant fecal impaction.Method:The BV (US Endoscopy) is a suction irrigation device fitted to the accessory biopsy port providing wider caliber for greater volume irrigation and suctioning. A therapeutic upper scope or a colonoscope should be used; the larger the channel the better the system works. The cleaning process is prolonged and requires great patience. Often one hour or more is needed and we have used up to 320 syringes a` 60 mL for a total of almost 20 L of water. The water should preferably be lukewarm so the patient does not get chilled. Using CO2 for insufflation is an advantage to prevent abdominal distension.Patients:We have treated four women with severe constipation. They had severe abdominal distension and traditional impaction therapy had failed. One was 56 y/o with scleroderma where a colovesical fistula was visualized after cleaning and the patient could go to surgery. Another was a 82 y/o with idiopathic pseudoobstruction full of hard stool in the left colon. It was cleaned with 2 sessions of BV. A few months later she came with impaction in right colon only, again successfully treated with BV. A 24 y/o with previous surgery for Hirschsprung’s disease who had no BM for 2 months after child delivery. Admitted twice to another hospital with no resolution. BV with 19.2 L of water resulted in passage of copious stool and patient was discharged home the following day. A 79 y/o with Parkinson’s disease and no BM for 1 month received BV and after that massive 17 cm colon distension went from 17 cm to 10 cm and she was discharged with resolution of the fecal impaction.Additionally
www.giejournal.org
components of gastric electro-mechanical activity. Although novel endoscopic techniques have been developed for temporary stimulation requiring external wires, permanent GES requires surgical implantation of a large, battery-based neurostimulator device. We have developed two new miniature gastric stimulators, one with a wirelessly rechargeable battery and the other wirelesslypowered without a battery.Method: Both designs were manufactured on printed circuit boards with wrapped antennas and packaged in soft polymer supporting 2 wires for electrode connection. Each design provides three settings (Table 1) and has a size of 12mmx3.7mmx0.9mm. In the first design, a rechargeable battery drives a reprogrammable pulse generator, while a magnetic reed switch permits alternation between charging and stimulation. In the second design, required pulse trains are generated through charge pump circuitry and a microcontroller that harvests radio-frequency energy from an external antenna. An acute pig model was employed with approval from and following protocols by the Animal Control Board of the University of Mississippi Medical Center. A 40kg anesthetized pig was endoscopically implanted with the electrical stimulator, and using electrodes attached serosally and mucosally, EGG recordings was made in response to stimulations. Mucosal and serosal EGG recording were analyzed by signal averaging for mean frequency and amplitude, as well as their ratio (FAR).Results: Shown in Table 2, both miniaturized models for electrical stimulation delivery produced changes in EGG, especially in FAR.Conclusion: We have demonstrated the feasibility of two types of miniature gastric stimulators in animal tests with successful modulation of gastric electrical activities. These stimulators offer the possible applications to endoscopic implantation of wireless systems. Table 1: Setting in each design. Dose Low Medium High
Pulse frequency Pulse duty cycle Pulse “On” time Pulse “Off” time 14Hz 28Hz 55Hz
0.46% 0.92% 1.82%
0.1s 1.0s 4.0s
5.0s 4.0s 1.0s
Table 2: Measurement results. Electrical Current
T1596 Predictors of Diagnostic Yield of Video Capsule Endoscopy in Southwest Ohio Veteran Population Chike C. Anusionwu, Khurram Bari, Sangeeta Agrawal, Salma Akram Background: Video capsule endoscopy (VCE) is an effective, minimally invasive technique that has revolutionized the study of small bowel (SB) pathology. However, there is paucity of data on which clinical factors predict higher yield of VCE to detect SB pathology. Aim:To determine the diagnostic yield of VCE and its predictors in the veterans seen at Dayton Veterans Affairs Medical Center(VAMC).Methods:All patients who underwent VCE from June 2007- August 2009 at the Dayton VAMC were included in the study. Data on patient demographics, indication for procedure, clinical setting of procedure, medication use at time of procedure, co-morbidities and VCE findings was collected by retrospective chart review. Univariate analysis was used to determine if any clinical or demographic variables were associated with VCE findings in these patients.Results: A total of 136 patients (95% male, n⫽129),74% Caucasian (n⫽100) with median age of 63 years (interquartile range{IQR}, 56-75 years) were studied. The median follow-up was 9 months (IQR, 4-14 months). All patients had previously undergone esophagogastroduodenoscopy and colonoscopy with negative results. VCE was carried out in an inpatient setting in 37 patients (27%). The median hemoglobin at the time of VCE was 10.7g/dl (IQR, 8.5-11.9 g/dl). The indication for the procedure was iron deficiency anemia in 88 patients (65%), overt bleeding (OB) in 33 patients (24%) and others ( e.g suspected mass in SB (n⫽6), chronic abdominal pain (n⫽5), suspected Crohn’s disease(n⫽2) and chronic diarrhea(n⫽2) in 15 patients (11%). Positive findings were identified in 66 patients (49%). The commonest findings were non-bleeding arteriovenous malformations (AVM) (n⫽26,19%), followed by SB mucosal irregularity (n⫽20,15%), bleeding AVM(n⫽ 8, 6%), SB ulceration (n⫽7, 5%), and SB mass (n⫽5, 4%). Female sex (9.1% vs. 1.4%, p⫽0.06), increasing age (p⫽0.19), use of non-steroidal anti-inflammatory drugs/aspirin (53% vs. 40%,p⫽0.17 ) and the presence of liver disease (13.6% vs. 5.7%,p⫽0.15 ) were non-significantly more likely to predict a positive yield on VCE.Conclusions: In our study population, gender, increasing age of patients, use of NSAIDS/aspirin and the presence of liver disease more likely led to positive yield on VCE. The explanation for the above findings is not entirely clear. Larger scale studies are needed to confirm the value of these clinical factors in determining positive diagnostic yield.
T1597 Miniature Wireless Gastric Electrical Stimulators Sanchali Deb, Thomas L. Abell, Filip To, Danielle C. Spree, Christopher J. Lahr, Wen-Ding Huang, J. C. Chiao Introduction: Gastric electrical stimulation (GES), an accepted therapy for drug refractory gastroparesis, applies electrical stimulation to tissues to help control
AB318 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
EGG Signal Summary
Stimulator
Power source
Dose
Mucosa
Serosa
Mean Freq. (Hz)
Freq. Range (Hz)
Mean Amp. (V)
Amp. Range (V)
#1
Rechargeable
Low
3.45mA
1.7mA
3.5
3.0-4.0
0.20
0.200.21 0.150.20 0.150.20 N/A
#2
Rechargeable
Medium
3.63mA
1.93mA
3.08
3.0-3.3
0.17
#3
Rechargeable
High
3.63mA
1.93mA
3.75
3.5-4.0
0.14
#4
Batteryless
Low
5.00mA
2.26mA
N/A
N/A
N/A
#5
Batteryless
Medium
5.00mA
2.26mA
3.00
3.0-3.1
0.06
#6
Batteryless
High
5.00mA
2.26mA
3.83
3.0-5.0
0.1
0.060.07 0.080.13
FAR (Hz/V) 17.5 18.1
Note Serosal EGG recording
26.8 N/A
50 38.3
EGG was not recorded Mucosal EGG recording
T1598 Novel Approach to Refractory Fecal Impaction Using LargeVolume Wide-Caliber Irrigation With BioVac Snorri Olafsson, Zebayel B. Akele, Carl Robinson, Christian S. Jackson, Amy Strickland Introduction:Fecal impaction is a solid, immobile bulk of stool. If traditional therapy with laxatives, manual fragmentation, enemas, sigmoidoscopy, and polyethylene glycol fail, surgery may be required. BioVac (BV) was developed to improve visibility in GI bleeding. We successfully used it off-label for resistant fecal impaction.Method:The BV (US Endoscopy) is a suction irrigation device fitted to the accessory biopsy port providing wider caliber for greater volume irrigation and suctioning. A therapeutic upper scope or a colonoscope should be used; the larger the channel the better the system works. The cleaning process is prolonged and requires great patience. Often one hour or more is needed and we have used up to 320 syringes a` 60 mL for a total of almost 20 L of water. The water should preferably be lukewarm so the patient does not get chilled. Using CO2 for insufflation is an advantage to prevent abdominal distension.Patients:We have treated four women with severe constipation. They had severe abdominal distension and traditional impaction therapy had failed. One was 56 y/o with scleroderma where a colovesical fistula was visualized after cleaning and the patient could go to surgery. Another was a 82 y/o with idiopathic pseudoobstruction full of hard stool in the left colon. It was cleaned with 2 sessions of BV. A few months later she came with impaction in right colon only, again successfully treated with BV. A 24 y/o with previous surgery for Hirschsprung’s disease who had no BM for 2 months after child delivery. Admitted twice to another hospital with no resolution. BV with 19.2 L of water resulted in passage of copious stool and patient was discharged home the following day. A 79 y/o with Parkinson’s disease and no BM for 1 month received BV and after that massive 17 cm colon distension went from 17 cm to 10 cm and she was discharged with resolution of the fecal impaction.Additionally
www.giejournal.org