- Email: [email protected]
T1604: Evaluation of Angiodysplasias in Patients in Oral Anticoagulant Therapy by Capsule Endoscopy
Abstracts
Technical success, no. (%) Reintervention, no. (%) Gastric cancer, no. (%) Nongastric cancer, no. (%) Survival duration, median, day (range)
50 (100) 14 (28.0) 11/ 31(36) 3/19(16) 122 (35148)
T1603 Endoscopic Cricopharyngeal Myotomy (ECM) for Zenker’s Diverticulum Using Hook Knife Stefan K. Goelder, Reinhard Scheubel, Helmut Messmann Introduction:Therapy of the Zenker’s diverticulum through flexible endoscopes has become an alternative to the surgical procedures. However, visibility if the muscle fibres to dissect can be impaired when using the argon plasma coagulator, and bleeding can be a problem with the needle knife. We introduce the hook knife as it is otherwise used for the endoscopic submucosal dissection technique for cutting the muscle septum between the diverticulum and the mouth of the esophagus.Methods: The procedure was performed through an Olympus GIF-Q-160 endoscope. Frist, the overtube ZDO-22-30 (manufactured by Cook Ireland Ltd., Limerick) was introduced and the muscular septum fixed. We used the Olympus Hook Knife KD-620LR with a rotable tip of 1.3 mm length. The ERBE electrosurgery device VIO 300 D was used with the following preselections: CUT MODE: off. COAG MODE: Spray Coag, Effect 2, max 60 W.Results:From 03/09-11/09 4 pts (age 71 year 1f/3m) were successful treated with 5 procedures. The treatment was performed in propofol sedation using the overtube (Cook ZDO-22-30) to fix the septum of the diverticulum. After incision of the mucosa and submucosa with the back-side of the hook-knife, we could dissect and cut the muscle fibres one after the other without any bleeding and very good visibility. No pt suffered from bleeding or perforation. No emphysema or pain occurred. The patients could drink the same day and started eating with soft food the day after the procedure. In one case the dissection was divided in two procedures, because the diverticular lumen was too large for a single treatment. In all patient dysphagia disappeared after the first procedure.Conclusion:Using the hook knife for dissection of the muscular septum in Zenker’s diverticulum is a new technique that offers excellent control and visibility during the procedure.
T1604 Evaluation of Angiodysplasias in Patients in Oral Anticoagulant Therapy by Capsule Endoscopy Maria Elena Riccioni, Rossella Cianci, Riccardo Urgesi, Cristiano Spada, Alessandra Bizzotto, Guido Costamagna BACKGROUND: Gastro-Intestinal (GI) bleeding is one of the main concerns in patients undergoing oral anticoagulation therapy. Angiodysplasias are the most frequent vascular lesions of the gastrointestinal tract and sources of significant mortality from bleeding. Small bowel angiodysplasias account for approximately 40% of cases of gastrointestinal bleeding with obscure origin and represent the single most common cause for hemorrhage in these patients. Their cause is unknown. Capsule endoscopy (CE) is the first-line method for evaluation of bleeding in patient after negative upper endoscopy and colonoscopy. OBJECTIVE: To investigate, by CE the frequency and features of GI lesions causes of bleeding in patients undergoing oral anticoagulant therapy. METHODS: Of a total of 750 CE obtained between January 2003 and November 2009, 401 were performed in patients with obscure gastrointestinal bleeding. Of these 401, 43 (10,72%) were obtained in patients undergoing oral anticoagulant therapy for different cardiovascular diseases. RESULTS: In our series, 21/43 (48.8%) patients had small-bowel angiodysplasias. Ten (23,25%) patients had negative examinations; the others had evidence of erosive gastritis (4 pts), jejunal erosions (3 pts), NSAIDs’ related lesions (1 patient), one diagnosis of coeliac disease, 1 small bowel inflammation, 1 Dieulafoy’s ulcer and 1 Meckel diverticulum. CONCLUSION: Even if it is well established that the sensitivity of capsule endoscopy (CE) performed during active bleeding is higher, small bowel angiodysplasias remain the main cause of occult GI bleeding. In our series, patients undergoing oral anticoagulant therapy had high prevalence of small bowel angiodysplasias. Angiodysplasias in these patients represent the 20,83% of total angiodysplasias found in 750 CE examinations.
T1605 Single-Balloon Push-and-Pull Enteroscopy System: Does It Work? A Single-Centre Three-Year-Experience Maria Elena Riccioni, Cristiano Spada, Rossella Cianci, Riccardo Urgesi, Guido Costamagna Background: the last decade has seen significant advances in evaluation of the small bowel. Several endoscopic techniques have been developed in recent
AB320 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
years; Capsule endoscopy (CE), double balloon enteroscopy (DBE) and more recently the single balloon enteroscopy (SBE).Objective: to evaluate diagnostic and therapeutic impact, safety and feasibility of SBE procedure after 3-yearexperienceMaterials and methods: From July 2006 to july 2009 , 73 SBE procedure were performed on 70 patients. Starting insertion route (oral or anal) of SBE was chosen according to the estimated location of the suspected lesions based on clinical presentation and, in 48 patients, on the findings of CE. Indications were: obscure gastrointestinal bleeding (31), suspected malabsorption syndrome (12), polyposis syndromes (11), suspected Crohn’s disease (9), suspected gastrointestinal tumor (7).Results: the SBE was not carried out in 4 patients for technical problems. Mean time to perform the examination using the oral and anal route was 60 ⫹/- 20 minutes and 70⫹/- 30 minutes respectively. Depth of insertion through the small bowel was 250 ⫹/- 80 cm. with oral SBE and 90 ⫹/- 30 cm. by the anal route, beyond the Treitz angle and the ileo-cecal valve respectively. The mean fluoroscopy time was 345.8 sec.In 9 patients multiple angiodysplasias were found and treated; in 8 patients with Peutz-Jeghers syndromes and FAP, multiple polypectomies were carried out; in 2 was performed endoscopic tattoos due to the big diameter of the polyps, in 1 only multiple biopsies. SBE diagnosed Crohn’s disease in 4 patients, malabsorption syndromes in 2, lymphangectasia in 2, eosinophilic enteritis in 1, melanoma in 1, in 8 aspecific inflammation. A total of seven small bowel tumors were diagnosed (all were tattooed). In 23/70 patients the exam was negative. No major complication occurred.Conclusions: The SBE seems to be safe, useful and highly effective in the diagnosis and therapy of several small bowel diseases.
T1607 Russian Experience in Transnasal Endoscopy Peter Shcherbakov, Leonid B. Lazebnik, Elena V. Bystrovskaya The aim of our study was to study opportunity the transnasal endoscopy.We use FUJINON GE 530 N endoscope in Central Scientific Research institute of gastroenterology (CSRIG) since 2008, March. We made our investigation in 2 phases. The 1-st phases was to estimate capabilities of using of TNE in everyday practice and characteristics of manipulation’s technique. It was over 297 manipulations. There was 123 men and 164 women, and the mean age was 48,3 ⫾ 4,6 years. Results of the 1-st step were very good. We provided 273 (91.9%)successful manipulations without any complications. But at 24 (8.1%) patients we had a TNE failure. The reason of this failure were narrowing of the nasal passages caused by traumatic injury (in history) of the nasal septum at 15 pts and swelling and bleeding of the nasal mucosa at 9 pts. The patients’ estimations of TNE was very interesting. They said that had a minimal expression or absence of gag reflex at apparatus insertion and during the procedure. They also had an ability to make a discussion with a doctor during procedure and had an absence of negative experience of upper endoscopy. And we interrogated doctors to receive their estimation of this manipulation. They found a simplicity of this procedure. Also they were gassed of improving the quality of visualization and increasing inspection due to good tolerability studies of patients. The second phase of our investigation was open randomized study to determining the level of situational anxiety before upper endoscopy using Spielberg Hanin‘s test . We investigated 110 patients. There was 67 men and 43 women, and the mean age was 51,2 ⫾ 3,6 years. All patients were randomized on three gruos. At the 1 Group (n⫽32) were patients with traditional UE. At the 2 Group (n⫽37)were patients at the first time TNE. At the 3 Group (n⫽41) were patients with repeated TNE that was made for control of treatment efficacy. We determined the anxiety level during TNE. Results showed that in the first group it was registered high anxiety level at 59.4% of endoscopies and medium anxiety level at 40.6% of endoscopies; in the second group it was registered high anxiety level at 64.9% of endoscopies and medium anxiety level at 35.1 % of endoscopies; in the third group it was registered medium anxiety level at 9.8% of endoscopies and low anxiety level at 90.2 % of endoscopies.Thus, TNE is safety manipulation with good mucosa visualization. It can be used in everyday practice because technique is simple and it is a good tolerance procedure for patients.
T1608 E-Worm and PillCam Colon Capsule: Feasibility and Patient Acceptance Mariabeatrice M. Principi, Raffaella R. Guido, Nicola De Tullio, Antonio Pisani, Francesca Albano, Antonio Francavilla, Alfredo Di Leo Conventional colonoscopy (CC) is the gold standard to diagnostic and therapeutic approach to colon, but also today patient acceptance is low for several reasons (pain, need of sedation, bowel preparation, and adverse events). Recently there was an increased activity in the application of new technologies to improve endoscopic techniques to achieve more effective diagnoses with reduction of pain and more uniform procedures, outside of manual abilities of the endoscopists. PillCam Colon capsule endoscope (PCC) (Given Imaging Ltd., Yoqneam, Israel) and E-worm (EW) (Estor S.p.A, Italy) are the most new, safe, mini-invasive modalities exploring colon. Actually there aren’t any literature data comparing these systems. Our purpose was to evaluate the feasibility and patient acceptance of the two new techniques compared with CC. Sixteen unselected
www.giejournal.org
Technical success, no. (%) Reintervention, no. (%) Gastric cancer, no. (%) Nongastric cancer, no. (%) Survival duration, median, day (range)
50 (100) 14 (28.0) 11/ 31(36) 3/19(16) 122 (35148)
T1603 Endoscopic Cricopharyngeal Myotomy (ECM) for Zenker’s Diverticulum Using Hook Knife Stefan K. Goelder, Reinhard Scheubel, Helmut Messmann Introduction:Therapy of the Zenker’s diverticulum through flexible endoscopes has become an alternative to the surgical procedures. However, visibility if the muscle fibres to dissect can be impaired when using the argon plasma coagulator, and bleeding can be a problem with the needle knife. We introduce the hook knife as it is otherwise used for the endoscopic submucosal dissection technique for cutting the muscle septum between the diverticulum and the mouth of the esophagus.Methods: The procedure was performed through an Olympus GIF-Q-160 endoscope. Frist, the overtube ZDO-22-30 (manufactured by Cook Ireland Ltd., Limerick) was introduced and the muscular septum fixed. We used the Olympus Hook Knife KD-620LR with a rotable tip of 1.3 mm length. The ERBE electrosurgery device VIO 300 D was used with the following preselections: CUT MODE: off. COAG MODE: Spray Coag, Effect 2, max 60 W.Results:From 03/09-11/09 4 pts (age 71 year 1f/3m) were successful treated with 5 procedures. The treatment was performed in propofol sedation using the overtube (Cook ZDO-22-30) to fix the septum of the diverticulum. After incision of the mucosa and submucosa with the back-side of the hook-knife, we could dissect and cut the muscle fibres one after the other without any bleeding and very good visibility. No pt suffered from bleeding or perforation. No emphysema or pain occurred. The patients could drink the same day and started eating with soft food the day after the procedure. In one case the dissection was divided in two procedures, because the diverticular lumen was too large for a single treatment. In all patient dysphagia disappeared after the first procedure.Conclusion:Using the hook knife for dissection of the muscular septum in Zenker’s diverticulum is a new technique that offers excellent control and visibility during the procedure.
T1604 Evaluation of Angiodysplasias in Patients in Oral Anticoagulant Therapy by Capsule Endoscopy Maria Elena Riccioni, Rossella Cianci, Riccardo Urgesi, Cristiano Spada, Alessandra Bizzotto, Guido Costamagna BACKGROUND: Gastro-Intestinal (GI) bleeding is one of the main concerns in patients undergoing oral anticoagulation therapy. Angiodysplasias are the most frequent vascular lesions of the gastrointestinal tract and sources of significant mortality from bleeding. Small bowel angiodysplasias account for approximately 40% of cases of gastrointestinal bleeding with obscure origin and represent the single most common cause for hemorrhage in these patients. Their cause is unknown. Capsule endoscopy (CE) is the first-line method for evaluation of bleeding in patient after negative upper endoscopy and colonoscopy. OBJECTIVE: To investigate, by CE the frequency and features of GI lesions causes of bleeding in patients undergoing oral anticoagulant therapy. METHODS: Of a total of 750 CE obtained between January 2003 and November 2009, 401 were performed in patients with obscure gastrointestinal bleeding. Of these 401, 43 (10,72%) were obtained in patients undergoing oral anticoagulant therapy for different cardiovascular diseases. RESULTS: In our series, 21/43 (48.8%) patients had small-bowel angiodysplasias. Ten (23,25%) patients had negative examinations; the others had evidence of erosive gastritis (4 pts), jejunal erosions (3 pts), NSAIDs’ related lesions (1 patient), one diagnosis of coeliac disease, 1 small bowel inflammation, 1 Dieulafoy’s ulcer and 1 Meckel diverticulum. CONCLUSION: Even if it is well established that the sensitivity of capsule endoscopy (CE) performed during active bleeding is higher, small bowel angiodysplasias remain the main cause of occult GI bleeding. In our series, patients undergoing oral anticoagulant therapy had high prevalence of small bowel angiodysplasias. Angiodysplasias in these patients represent the 20,83% of total angiodysplasias found in 750 CE examinations.
T1605 Single-Balloon Push-and-Pull Enteroscopy System: Does It Work? A Single-Centre Three-Year-Experience Maria Elena Riccioni, Cristiano Spada, Rossella Cianci, Riccardo Urgesi, Guido Costamagna Background: the last decade has seen significant advances in evaluation of the small bowel. Several endoscopic techniques have been developed in recent
AB320 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
years; Capsule endoscopy (CE), double balloon enteroscopy (DBE) and more recently the single balloon enteroscopy (SBE).Objective: to evaluate diagnostic and therapeutic impact, safety and feasibility of SBE procedure after 3-yearexperienceMaterials and methods: From July 2006 to july 2009 , 73 SBE procedure were performed on 70 patients. Starting insertion route (oral or anal) of SBE was chosen according to the estimated location of the suspected lesions based on clinical presentation and, in 48 patients, on the findings of CE. Indications were: obscure gastrointestinal bleeding (31), suspected malabsorption syndrome (12), polyposis syndromes (11), suspected Crohn’s disease (9), suspected gastrointestinal tumor (7).Results: the SBE was not carried out in 4 patients for technical problems. Mean time to perform the examination using the oral and anal route was 60 ⫹/- 20 minutes and 70⫹/- 30 minutes respectively. Depth of insertion through the small bowel was 250 ⫹/- 80 cm. with oral SBE and 90 ⫹/- 30 cm. by the anal route, beyond the Treitz angle and the ileo-cecal valve respectively. The mean fluoroscopy time was 345.8 sec.In 9 patients multiple angiodysplasias were found and treated; in 8 patients with Peutz-Jeghers syndromes and FAP, multiple polypectomies were carried out; in 2 was performed endoscopic tattoos due to the big diameter of the polyps, in 1 only multiple biopsies. SBE diagnosed Crohn’s disease in 4 patients, malabsorption syndromes in 2, lymphangectasia in 2, eosinophilic enteritis in 1, melanoma in 1, in 8 aspecific inflammation. A total of seven small bowel tumors were diagnosed (all were tattooed). In 23/70 patients the exam was negative. No major complication occurred.Conclusions: The SBE seems to be safe, useful and highly effective in the diagnosis and therapy of several small bowel diseases.
T1607 Russian Experience in Transnasal Endoscopy Peter Shcherbakov, Leonid B. Lazebnik, Elena V. Bystrovskaya The aim of our study was to study opportunity the transnasal endoscopy.We use FUJINON GE 530 N endoscope in Central Scientific Research institute of gastroenterology (CSRIG) since 2008, March. We made our investigation in 2 phases. The 1-st phases was to estimate capabilities of using of TNE in everyday practice and characteristics of manipulation’s technique. It was over 297 manipulations. There was 123 men and 164 women, and the mean age was 48,3 ⫾ 4,6 years. Results of the 1-st step were very good. We provided 273 (91.9%)successful manipulations without any complications. But at 24 (8.1%) patients we had a TNE failure. The reason of this failure were narrowing of the nasal passages caused by traumatic injury (in history) of the nasal septum at 15 pts and swelling and bleeding of the nasal mucosa at 9 pts. The patients’ estimations of TNE was very interesting. They said that had a minimal expression or absence of gag reflex at apparatus insertion and during the procedure. They also had an ability to make a discussion with a doctor during procedure and had an absence of negative experience of upper endoscopy. And we interrogated doctors to receive their estimation of this manipulation. They found a simplicity of this procedure. Also they were gassed of improving the quality of visualization and increasing inspection due to good tolerability studies of patients. The second phase of our investigation was open randomized study to determining the level of situational anxiety before upper endoscopy using Spielberg Hanin‘s test . We investigated 110 patients. There was 67 men and 43 women, and the mean age was 51,2 ⫾ 3,6 years. All patients were randomized on three gruos. At the 1 Group (n⫽32) were patients with traditional UE. At the 2 Group (n⫽37)were patients at the first time TNE. At the 3 Group (n⫽41) were patients with repeated TNE that was made for control of treatment efficacy. We determined the anxiety level during TNE. Results showed that in the first group it was registered high anxiety level at 59.4% of endoscopies and medium anxiety level at 40.6% of endoscopies; in the second group it was registered high anxiety level at 64.9% of endoscopies and medium anxiety level at 35.1 % of endoscopies; in the third group it was registered medium anxiety level at 9.8% of endoscopies and low anxiety level at 90.2 % of endoscopies.Thus, TNE is safety manipulation with good mucosa visualization. It can be used in everyday practice because technique is simple and it is a good tolerance procedure for patients.
T1608 E-Worm and PillCam Colon Capsule: Feasibility and Patient Acceptance Mariabeatrice M. Principi, Raffaella R. Guido, Nicola De Tullio, Antonio Pisani, Francesca Albano, Antonio Francavilla, Alfredo Di Leo Conventional colonoscopy (CC) is the gold standard to diagnostic and therapeutic approach to colon, but also today patient acceptance is low for several reasons (pain, need of sedation, bowel preparation, and adverse events). Recently there was an increased activity in the application of new technologies to improve endoscopic techniques to achieve more effective diagnoses with reduction of pain and more uniform procedures, outside of manual abilities of the endoscopists. PillCam Colon capsule endoscope (PCC) (Given Imaging Ltd., Yoqneam, Israel) and E-worm (EW) (Estor S.p.A, Italy) are the most new, safe, mini-invasive modalities exploring colon. Actually there aren’t any literature data comparing these systems. Our purpose was to evaluate the feasibility and patient acceptance of the two new techniques compared with CC. Sixteen unselected
www.giejournal.org