- Email: [email protected]
Tu1585 Absence of Mutual Interference Between Capsule Endoscopy and Implantable Cardiac Defibrillators: A Clinical Electrophysiological Study
Abstracts
in an academic medical center. Results: More than 200 DBE cases were performed under either MS or MAC/GA from 2008 to 2010. Of these cases, sufficient data was retrieved from total of 123 procedures [85 anterograde DBE (aDBE) and 38 retrograde DBE rDBE)] for full analysis. The mean age of the patients was 59.65 yrs (GA) and 59.32 yrs (MS). A total of 43 patients underwent DBE with GA (33 aDBE, 10 rDBE) and 74 with MS (47 aDBE 27 rDBE). The average procedure time for aDBE was 135 minutes [129 min GA Vs. 117 min MS (P⫽ 0.0062)]. Average procedure time for rDBE was 110 minutes [96 min GA Vs. 117 min MS (P 0.2568)]. Average depth of insertion for aDBE was 458 cm for GA Vs. 358 cm for MS (P⫽0.0814). Unidirectional total enteroscopy was achieved during procedures utilizing both MS and GA. The average sedation requirement under moderate sedation was as follows: Meperidine- 168 mg; Fentanyl- 137.5 mg; Midazolam- 9.6 mg; Promethazine- 21.6 mg; and Diphenhydramine- 49 mg. The procedure was terminated early in 3 patients under MS due to increased agitation, while 2 patients under GA in this subset had anesthesia related complications. Conclusions: This retrospective review suggests that moderate Sedation, despite some limitations, is a safe and effective method of sedation for anterograde or retrograde DBE. Adequate depth of insertion, including total unidirectional enteroscopy can be achieved using moderate sedation. The additional use of Diphenhydramine for sedation may help decrease the overall sedative requirements. moreover, co-morbid medical conditions, prior sedation history, chronic narcotic use, and anesthesiology availability should factor into the decision regarding method of sedation for Double-Balloon Enteroscopy.
Tu1585 Absence of Mutual Interference Between Capsule Endoscopy and Implantable Cardiac Defibrillators: A Clinical Electrophysiological Study Dario Moneghini1, Alessandro Lipari2, Guido Missale1, Luigi Minelli1, Gianpaolo Cengia1, Luca Bontempi2, Antonio Curnis2, Renzo Cestari1 1 Surgery, Digestive Endoscopy Unit Spedali Civili of Brescia, Brescia, Italy; 2Chair of Cardiology, Electrophysiology and Electrostimulation Lab, Brescia, Italy
Tu1584 The Efficacy and Safety of Moderate Sedation for DoubleBalloon Enteroscopy F. O. Stephen1, Bianca B. Afonso1, Jose M. Guillen-Rodriguez2, Thomas Prindiville3 1 Gastroenterology, The University of Arizona, Tucson, AZ; 2 Biostatistics, University of Arizona, Arizona Cancer Center, Tucson, AZ; 3Gastroenterology & Hepatology, University of California, Davis, Sacramento, CA
Capsule endoscopy (CE) has recently become one of the most important tools for small bowel investigation. Once swallowed by the patient, capsule transmits images from the gut to an external recorder over a digital radiofrequency communication channel of 434 MHz. A potential interference with implantable cardiac devices has been postulated, so their presence is considered a relative contraindication for CE. Whereas safety data about CE in patients with pace makers are now available, studies in patients with implantable cardiac defibrillators (ICD) are lacking. We report the use of Given M2A video capsule system (Pillcam; Given Imaging Ltd, Yoqneam, Israel) in 7 patients with ICD over a 2-years period. During CE patients were continuously monitored with cardiac telemetry, performed in a hospital setting (Cardiac Care Unit). All patients gave their written informed consent. For all the patients indication for CE was obscure gastrointestinal bleeding (OGIB), occult in 4 cases and overt in 3. Mean age was 68,3 years; all the patients were males. Patients data, ICD parameters and results of recording are reported in the table.Capsule reached ileo-cecal valve in all except one cases. No complications related to capsule transit were observed. No technical problems related to imagine transmission were recorded. Causes of OGIB were found in 57,1% of cases (100% in overt OGIB patients and 25% in occult OGIB). No ICD malfunction nor interference in sensing or pacing were recorded; conversely, no malfunction of CE caused by ICD was registered. Our results suggest that CE can be safely performed in patients with different types of ICDs.
Background: While moderate (conscious) sedation (MS) and monitored anesthesia care (MAC) are the primary methods of sedation for Double-Balloon Enteroscopy (DBE) in Japan and Europe, there is a progressive trend towards the use of MAC or general anesthesia (GA)for DBE procedures in the United States. This is in part due to concerns for patient safety, procedure tolerance, and risk of complications during lengthy procedures. Limited availability of anesthesiologists can thus significantly impact the efficiency in scheduling these procedures. There is limited data in the U.S. assessing the risk and efficiency of procedures under MS to explain this shift towards the use of MAC and GA. We provide a retrospective comparison of the safety and efficacy of DBE performed under moderate sedation and MAC/GA. Methods: Retrospective review of anterograde and retrograde Double-Balloon Enteroscopy procedures performed
AB454 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011
www.giejournal.org
Abstracts
1
Patient ICD Results during CE exam Changes in device parameters
Inappropriate Shocks Inappropriate antitachycardia therapy Inappropriate Sensing Inappropriate Pacing Noise Detected Device Reset Programmation Changes Permanent Electrical Damages
Boston Scientific Teligen 100
2
Guidant Vitality 2 DR
3
Medtronic In Sinc III Marquis
4
5
6
7
Boston Scientific Guidant Sorin Medtronic Paradym Cognis Vitality 2 DR 100 CRT Secura DR
Patient 1 2
3 (AH) NO
NO
Sensing switched to maximum (0,18 mV) NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO NO
NO NO
NO NO
NO NO
NO NO
NO NO
NO NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO 4
5 6
CE Findings Ileum
% Small Changes in Bowel Clinical Management Involvement
No lesions
DNLH
DNLH
No lesions
No lesions
31
No lesions Chronic diarrhea malabsorption Chronic DNLH diarrhea
No lesions
Crohn’s like Enteroscopy lesions with biopsies No lesions None
None
32
None None
No lesions No lesions
DNLH ⫹ Crohn’s like lesions DNLH SNLH
None None
6 3
No lesions No lesions
NO LESIONS
None
66
0
Tu1587 Impact of Capsule Endoscopy in the Clinical Management and Outcome of Patients: A 5-Year Experience Rui Gao, Irfan Amin, Jeremy M. Woodward Addenbrooke’s Hospital, Cambridge, United Kingdom
Tu1586 Small Bowel Capsule Endoscopy in Common Variable Immunodeficiency Disorder and Acquired Hypogammaglobulinemia Dario Moneghini1, Guido Missale1, Paolo Airò2, Micol Frassi2, Luigi Minelli1, Gianpaolo Cengia1, Cartella Stefania2, Scarsi Mirko2, Renzo Cestari1 1 Surgery, Digestive Endoscopy Unit Spedali Civili of Brescia, Brescia, Italy; 2Medicine, Rheumatology and Clinical Immunology Unit, Brescia, Italy Common variable immunodeficiency disorder (CVID) is an umoral immnune defect due to low serum IgG levels, resulting in increased susceptibility to infections and to malignancy, especially lymphomas. Disturbances in gut immune/bacterial symbiosis and homeostasis can lead to chronic gut inflammation and associated malabsorption. In some individuals intestinal involvement resembles the clinical features of inflammatory bowel diseases or exhibits sporadic or diffuse nodular lymphoid hyperplasia (SNLH-DNLH). International guidelines recommend to perform biopsies of any enlarged lymphoid tissue and to investigate GI symptoms. Anedoctal reports (series with no more than 3 cases) suggest a possible role of capsule endoscopy (CE) in defining bowel involvement in CVID. In 2010 we started a prospective study using the Given M2A video capsule system (Pillcam; Given Imaging Ltd, Yoqneam, Israel) in order to assess the clinical impact of CE in CVID patients. Hereafter we report the preliminary findings over a 1-year period in the first 5 CVID cases and in a patient with acquired hypogammaglobulinemia (AH). Capsule ingestion was performed in the morning after a overnight fast. The day before the exam bowel preparation with 2L of polyethylene glycol solution was administered. All patients gave their written informed consent. Four patients were females. The mean age was 44,8 years (range 28-72). The CE-derived data are prospectively recorded and analyzed in terms of safety, endoscopic findings, diagnostic yield and impact on subsequent treatment. Capsule reached ileo-cecal valve without complications in all the cases. No technical problems related to imagine transmission were recorded. The percentage of gut involvement was calculated on the basis of small bowel transit time. Patients data and CE results are reported in the following table.Our results suggest that CE is a safe and useful tool in defining presence and extent of nodular lymphoid hyperplasia and other lesions in CVID. SNLH or DNLH were found in all and Crohn’s like lesions (erosions and small ulcers) in 40% of patients, irrespectively of presence of symptoms. Furthermore, CE showed that DNLH can affect each segment of the small bowel. Interestingly, no lesions were found in AH. CE allowed significant changes in clinical management in 20% of patients but closer follow up was recommended for all the patients with DNLH. Larger studies are needed to confirm a possible role of CE in identifying patients at high risk for small bowel lymphoma.
www.giejournal.org
Symptoms Chronic diarrhea Chronic diarrhea
CE Findings CE Findings Duodenum Jejunum
Introduction: The small bowel has historically been a difficult area to examine. The advent of capsule endoscopy (CE) has presented new opportunities to assess small bowel (SB) conditions. For obscure gastrointestinal bleeding (OGIB), CE has shown superior results compared to radiographic studies and push enteroscopy. The use of CE is cost effective by preventing unnecessary cycles of investigations in patients. Methods: A retrospective review of all patients who underwent CE in a tertiary referral centre in the UK between 2004 and 2009 was performed. Data were collected on patient demographics, indications, diagnosis and management following CE. We evaluated the impact of CE on management and outcomes. Results: Over a five year period, 340 patients underwent CE of which 73.6% (n⫽231) patients were referred from our teaching hospital, 26.4% (n⫽109) from 6 local District General Hospitals. 52.3% (n⫽178) had iron deficiency anaemia (IDA), 22.6% (n⫽77) had overt OGIB, 6.4% (n⫽22) had possible Crohn’s disease, 4.7% (n⫽16) had unexplained abdominal pain, 4.7% (n⫽16) had refractory coeliac disease, 3.8% (n⫽13) had unexplained diarrhoea, 3.2% (n⫽11) had unspecified anaemia.SB abnormalities were found in 57.1% of patients, with angiodysplasia being the most common in 17.1% of patients. Other findings included ulceration or inflammation 13.0%, fresh blood or altered blood 5.0%, stricture(s) 4.1%, villous atrophy 2.9%, Crohn’s disease 2.6%, and lesion (including tumor, polyp and lipoma) 5.9%. In addition CE diagnosed gastric abnormalities (ulcers and erosions) in 5.1% of examinations.By the end of the eight hour recording time, CE reached colon in 75.2% of examinations. Capsule retention rate was 0.6%.Outcomes and further management were measured in 164 patients. Overall CE was able to provide diagnosis corresponding to patients’ symptoms in 38.4% (n⫽63). CE led to change of clinical management in 43.3% of patients with initiation of definitive treatment or further investigations. Conclusions: CE remains an important diagnostic tool for a wide variety of SB pathology leading to significant change in management. In our study CE diagnosed SB abnormalities in 57.1% of patients and led to change in clinical management in 43.3% of patients.
Tu1588 Comparison of Narrow Band Imaging With High Resolution White Light Endoscopy for the Assessment of Non Steroidal Anti-Inflammatory Drug Induced Gastroduodenal Injury Venkataraman Subramanian, Emmanouil Telakis, Jayan Mannath, Vidyasagar Ramappa, Matthew Wireko, Krish Ragunath, Chris J. Hawkey Nottingham Digestive Diseases Centre, Nottingham University Hospital, Nottingham, United Kingdom Introduction: The diagnosis of NSAID induced gastro-duodenal injury is often associated with difficulties in determination of the degree of injury. The Lanza score and its many modifications are commonly used in clinical trials, but are considered subjective and susceptible to errors in interpretation. The aim of this study was to determine the inter-observer variability in assessing NSAID induced gastro-duodenal injury among endoscopists with and without experience in narrow band imaging (NBI) using both high resolution white light endoscopy (HR-WLE) and NBI. Methods: Corresponding NBI and HR-WLE images were taken during endoscopy from healthy volunteers taking different NSAID preparations. Six blinded endoscopists (3 experts in NBI imaging) counted the number of ulcers, erosions and hemorrhagic lesions to derive a 5 point modified
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB455
in an academic medical center. Results: More than 200 DBE cases were performed under either MS or MAC/GA from 2008 to 2010. Of these cases, sufficient data was retrieved from total of 123 procedures [85 anterograde DBE (aDBE) and 38 retrograde DBE rDBE)] for full analysis. The mean age of the patients was 59.65 yrs (GA) and 59.32 yrs (MS). A total of 43 patients underwent DBE with GA (33 aDBE, 10 rDBE) and 74 with MS (47 aDBE 27 rDBE). The average procedure time for aDBE was 135 minutes [129 min GA Vs. 117 min MS (P⫽ 0.0062)]. Average procedure time for rDBE was 110 minutes [96 min GA Vs. 117 min MS (P 0.2568)]. Average depth of insertion for aDBE was 458 cm for GA Vs. 358 cm for MS (P⫽0.0814). Unidirectional total enteroscopy was achieved during procedures utilizing both MS and GA. The average sedation requirement under moderate sedation was as follows: Meperidine- 168 mg; Fentanyl- 137.5 mg; Midazolam- 9.6 mg; Promethazine- 21.6 mg; and Diphenhydramine- 49 mg. The procedure was terminated early in 3 patients under MS due to increased agitation, while 2 patients under GA in this subset had anesthesia related complications. Conclusions: This retrospective review suggests that moderate Sedation, despite some limitations, is a safe and effective method of sedation for anterograde or retrograde DBE. Adequate depth of insertion, including total unidirectional enteroscopy can be achieved using moderate sedation. The additional use of Diphenhydramine for sedation may help decrease the overall sedative requirements. moreover, co-morbid medical conditions, prior sedation history, chronic narcotic use, and anesthesiology availability should factor into the decision regarding method of sedation for Double-Balloon Enteroscopy.
Tu1585 Absence of Mutual Interference Between Capsule Endoscopy and Implantable Cardiac Defibrillators: A Clinical Electrophysiological Study Dario Moneghini1, Alessandro Lipari2, Guido Missale1, Luigi Minelli1, Gianpaolo Cengia1, Luca Bontempi2, Antonio Curnis2, Renzo Cestari1 1 Surgery, Digestive Endoscopy Unit Spedali Civili of Brescia, Brescia, Italy; 2Chair of Cardiology, Electrophysiology and Electrostimulation Lab, Brescia, Italy
Tu1584 The Efficacy and Safety of Moderate Sedation for DoubleBalloon Enteroscopy F. O. Stephen1, Bianca B. Afonso1, Jose M. Guillen-Rodriguez2, Thomas Prindiville3 1 Gastroenterology, The University of Arizona, Tucson, AZ; 2 Biostatistics, University of Arizona, Arizona Cancer Center, Tucson, AZ; 3Gastroenterology & Hepatology, University of California, Davis, Sacramento, CA
Capsule endoscopy (CE) has recently become one of the most important tools for small bowel investigation. Once swallowed by the patient, capsule transmits images from the gut to an external recorder over a digital radiofrequency communication channel of 434 MHz. A potential interference with implantable cardiac devices has been postulated, so their presence is considered a relative contraindication for CE. Whereas safety data about CE in patients with pace makers are now available, studies in patients with implantable cardiac defibrillators (ICD) are lacking. We report the use of Given M2A video capsule system (Pillcam; Given Imaging Ltd, Yoqneam, Israel) in 7 patients with ICD over a 2-years period. During CE patients were continuously monitored with cardiac telemetry, performed in a hospital setting (Cardiac Care Unit). All patients gave their written informed consent. For all the patients indication for CE was obscure gastrointestinal bleeding (OGIB), occult in 4 cases and overt in 3. Mean age was 68,3 years; all the patients were males. Patients data, ICD parameters and results of recording are reported in the table.Capsule reached ileo-cecal valve in all except one cases. No complications related to capsule transit were observed. No technical problems related to imagine transmission were recorded. Causes of OGIB were found in 57,1% of cases (100% in overt OGIB patients and 25% in occult OGIB). No ICD malfunction nor interference in sensing or pacing were recorded; conversely, no malfunction of CE caused by ICD was registered. Our results suggest that CE can be safely performed in patients with different types of ICDs.
Background: While moderate (conscious) sedation (MS) and monitored anesthesia care (MAC) are the primary methods of sedation for Double-Balloon Enteroscopy (DBE) in Japan and Europe, there is a progressive trend towards the use of MAC or general anesthesia (GA)for DBE procedures in the United States. This is in part due to concerns for patient safety, procedure tolerance, and risk of complications during lengthy procedures. Limited availability of anesthesiologists can thus significantly impact the efficiency in scheduling these procedures. There is limited data in the U.S. assessing the risk and efficiency of procedures under MS to explain this shift towards the use of MAC and GA. We provide a retrospective comparison of the safety and efficacy of DBE performed under moderate sedation and MAC/GA. Methods: Retrospective review of anterograde and retrograde Double-Balloon Enteroscopy procedures performed
AB454 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011
www.giejournal.org
Abstracts
1
Patient ICD Results during CE exam Changes in device parameters
Inappropriate Shocks Inappropriate antitachycardia therapy Inappropriate Sensing Inappropriate Pacing Noise Detected Device Reset Programmation Changes Permanent Electrical Damages
Boston Scientific Teligen 100
2
Guidant Vitality 2 DR
3
Medtronic In Sinc III Marquis
4
5
6
7
Boston Scientific Guidant Sorin Medtronic Paradym Cognis Vitality 2 DR 100 CRT Secura DR
Patient 1 2
3 (AH) NO
NO
Sensing switched to maximum (0,18 mV) NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO NO
NO NO
NO NO
NO NO
NO NO
NO NO
NO NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO 4
5 6
CE Findings Ileum
% Small Changes in Bowel Clinical Management Involvement
No lesions
DNLH
DNLH
No lesions
No lesions
31
No lesions Chronic diarrhea malabsorption Chronic DNLH diarrhea
No lesions
Crohn’s like Enteroscopy lesions with biopsies No lesions None
None
32
None None
No lesions No lesions
DNLH ⫹ Crohn’s like lesions DNLH SNLH
None None
6 3
No lesions No lesions
NO LESIONS
None
66
0
Tu1587 Impact of Capsule Endoscopy in the Clinical Management and Outcome of Patients: A 5-Year Experience Rui Gao, Irfan Amin, Jeremy M. Woodward Addenbrooke’s Hospital, Cambridge, United Kingdom
Tu1586 Small Bowel Capsule Endoscopy in Common Variable Immunodeficiency Disorder and Acquired Hypogammaglobulinemia Dario Moneghini1, Guido Missale1, Paolo Airò2, Micol Frassi2, Luigi Minelli1, Gianpaolo Cengia1, Cartella Stefania2, Scarsi Mirko2, Renzo Cestari1 1 Surgery, Digestive Endoscopy Unit Spedali Civili of Brescia, Brescia, Italy; 2Medicine, Rheumatology and Clinical Immunology Unit, Brescia, Italy Common variable immunodeficiency disorder (CVID) is an umoral immnune defect due to low serum IgG levels, resulting in increased susceptibility to infections and to malignancy, especially lymphomas. Disturbances in gut immune/bacterial symbiosis and homeostasis can lead to chronic gut inflammation and associated malabsorption. In some individuals intestinal involvement resembles the clinical features of inflammatory bowel diseases or exhibits sporadic or diffuse nodular lymphoid hyperplasia (SNLH-DNLH). International guidelines recommend to perform biopsies of any enlarged lymphoid tissue and to investigate GI symptoms. Anedoctal reports (series with no more than 3 cases) suggest a possible role of capsule endoscopy (CE) in defining bowel involvement in CVID. In 2010 we started a prospective study using the Given M2A video capsule system (Pillcam; Given Imaging Ltd, Yoqneam, Israel) in order to assess the clinical impact of CE in CVID patients. Hereafter we report the preliminary findings over a 1-year period in the first 5 CVID cases and in a patient with acquired hypogammaglobulinemia (AH). Capsule ingestion was performed in the morning after a overnight fast. The day before the exam bowel preparation with 2L of polyethylene glycol solution was administered. All patients gave their written informed consent. Four patients were females. The mean age was 44,8 years (range 28-72). The CE-derived data are prospectively recorded and analyzed in terms of safety, endoscopic findings, diagnostic yield and impact on subsequent treatment. Capsule reached ileo-cecal valve without complications in all the cases. No technical problems related to imagine transmission were recorded. The percentage of gut involvement was calculated on the basis of small bowel transit time. Patients data and CE results are reported in the following table.Our results suggest that CE is a safe and useful tool in defining presence and extent of nodular lymphoid hyperplasia and other lesions in CVID. SNLH or DNLH were found in all and Crohn’s like lesions (erosions and small ulcers) in 40% of patients, irrespectively of presence of symptoms. Furthermore, CE showed that DNLH can affect each segment of the small bowel. Interestingly, no lesions were found in AH. CE allowed significant changes in clinical management in 20% of patients but closer follow up was recommended for all the patients with DNLH. Larger studies are needed to confirm a possible role of CE in identifying patients at high risk for small bowel lymphoma.
www.giejournal.org
Symptoms Chronic diarrhea Chronic diarrhea
CE Findings CE Findings Duodenum Jejunum
Introduction: The small bowel has historically been a difficult area to examine. The advent of capsule endoscopy (CE) has presented new opportunities to assess small bowel (SB) conditions. For obscure gastrointestinal bleeding (OGIB), CE has shown superior results compared to radiographic studies and push enteroscopy. The use of CE is cost effective by preventing unnecessary cycles of investigations in patients. Methods: A retrospective review of all patients who underwent CE in a tertiary referral centre in the UK between 2004 and 2009 was performed. Data were collected on patient demographics, indications, diagnosis and management following CE. We evaluated the impact of CE on management and outcomes. Results: Over a five year period, 340 patients underwent CE of which 73.6% (n⫽231) patients were referred from our teaching hospital, 26.4% (n⫽109) from 6 local District General Hospitals. 52.3% (n⫽178) had iron deficiency anaemia (IDA), 22.6% (n⫽77) had overt OGIB, 6.4% (n⫽22) had possible Crohn’s disease, 4.7% (n⫽16) had unexplained abdominal pain, 4.7% (n⫽16) had refractory coeliac disease, 3.8% (n⫽13) had unexplained diarrhoea, 3.2% (n⫽11) had unspecified anaemia.SB abnormalities were found in 57.1% of patients, with angiodysplasia being the most common in 17.1% of patients. Other findings included ulceration or inflammation 13.0%, fresh blood or altered blood 5.0%, stricture(s) 4.1%, villous atrophy 2.9%, Crohn’s disease 2.6%, and lesion (including tumor, polyp and lipoma) 5.9%. In addition CE diagnosed gastric abnormalities (ulcers and erosions) in 5.1% of examinations.By the end of the eight hour recording time, CE reached colon in 75.2% of examinations. Capsule retention rate was 0.6%.Outcomes and further management were measured in 164 patients. Overall CE was able to provide diagnosis corresponding to patients’ symptoms in 38.4% (n⫽63). CE led to change of clinical management in 43.3% of patients with initiation of definitive treatment or further investigations. Conclusions: CE remains an important diagnostic tool for a wide variety of SB pathology leading to significant change in management. In our study CE diagnosed SB abnormalities in 57.1% of patients and led to change in clinical management in 43.3% of patients.
Tu1588 Comparison of Narrow Band Imaging With High Resolution White Light Endoscopy for the Assessment of Non Steroidal Anti-Inflammatory Drug Induced Gastroduodenal Injury Venkataraman Subramanian, Emmanouil Telakis, Jayan Mannath, Vidyasagar Ramappa, Matthew Wireko, Krish Ragunath, Chris J. Hawkey Nottingham Digestive Diseases Centre, Nottingham University Hospital, Nottingham, United Kingdom Introduction: The diagnosis of NSAID induced gastro-duodenal injury is often associated with difficulties in determination of the degree of injury. The Lanza score and its many modifications are commonly used in clinical trials, but are considered subjective and susceptible to errors in interpretation. The aim of this study was to determine the inter-observer variability in assessing NSAID induced gastro-duodenal injury among endoscopists with and without experience in narrow band imaging (NBI) using both high resolution white light endoscopy (HR-WLE) and NBI. Methods: Corresponding NBI and HR-WLE images were taken during endoscopy from healthy volunteers taking different NSAID preparations. Six blinded endoscopists (3 experts in NBI imaging) counted the number of ulcers, erosions and hemorrhagic lesions to derive a 5 point modified
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB455