Introduction  Patient comfort is an important part of endoscopy and reflects procedure quality and endoscopist technique. Using the validated, Nurse Assisted Patient Comfort Score (NAPCOMS), this study aimed to determine whether the introduction of NAPCOMS would affect sedation use by endoscopists. Patients and methods  The study was conducted over 3 phases. Phase One and Two consisted of 8 weeks of endoscopist blinded and aware data collection, respectively. Data in Phase Three was collected over a 5-month period and scores fed back to individual endoscopists on a monthly basis. Results  NAPCOMS consists of 3 domains – pain, sedation, and global tolerability. Comparison of Phase One and Two, showed no significant differences in sedative use or NAPCOMS. Phase Three data showed a decline in fentanyl use between individual months ( P  = 0.035), but no change in overall NAPCOMS. Procedures involving trainees were found to use more midazolam ( P  = 0.01) and fentanyl ( P  = 0.01), have worse NAPCOMS scores, and resulted in longer procedure duration ( P  < 0.001). Data comparing gastroenterologists and general surgeons showed increased fentanyl use ( P  = 0.037), decreased midazolam use ( P  = 0.001), and more position changes ( P  = 0.002) among gastroenterologists. Conclusions  The introduction of a patient comfort scoring system resulted in a decrease in fentanyl use, although with minimal clinical significance. Additional studies are required to determine the role of patient comfort scores in quality control in endoscopy. Procedures completed with trainees used more sedation, were longer, and had worse NAPCOMS scores, the implications of which, for teaching hospitals and training programs, will need to be further considered.

An end-to-side microsurgical vascular anastomosis involves the creation of an arteriotomy in the recipient vessel to facilitate the attachment of a donor vessel. We describe the use of a punch biopsy forceps as a simple, effective, and novel aid to performing an end-to-side arterial anastomosis.

Background Tissue sampling is often limited to acquisition of one to two biopsy samples during a single pass. The ability to obtain more than two biopsies during a single pass can improve diagnostic yield however is potentially limited by poor specimen quality and loss of specimens. The multibite forceps used in this study have a unique geometry with the ability to store up to six biopsy samples taken consecutively with easy removal of the samples when shaken in solution. If multiple biopsies can be taken during a single pass with preserved specimen quality then we can reduce procedure time, improve efficiency and sensitivity of biopsies. Aims To evaluate the histological quality of the first biopsy sample compared to the last (sixth) biopsy sample acquired consecutively with the multibite forcep during a single act. Methods A porcine stomach was coloured with surgical dye to create six separate segments. An experienced endoscopist used single use disposable MultiCROC multi-sampling biopsy forceps to acquire six consecutive biopsies. Biopsies were manually separated into the order of which they were acquired (biopsy one through six) and each sample was placed in formalin solution. A total of 35 sets of 6 biopsies were obtained producing a total of 210 samples. Samples were randomized and two independent pathologists who were blinded to the biopsy order assessed the histological quality of specimens. Specimens were evaluated for presence of full thickness mucosa, absence of fragmentation, crush artifact and diagnostic utility. Each pathologist then scored each specimen and the mean scores were used to compare the histological quality of the first biopsy vs. the sixth biopsy for each set. Results Our preliminary results include 12 of the 35 sets of biopsies. Using a paired sample t test, there was no significant difference between the mean score given to biopsy one and biopsy six for all twelve pairs [3.62 (SD 1.46) vs. 3.67 (SD 1.15), correlation factor=0.498 and p=.10). There was no significant difference between the first and sixth biopsy when comparing the presence of full thickness mucosa [0.59 (SD 0.49) vs. 0.59 (SD 0.44), p=.086], absence of fragmentation [0.50 (SD 0.50) vs. 0.73 (SD 0.34), p=0.06], absence of crush artifact [0.96 (SD 0.15) vs. 0.91 (SD 0.30), p=0.77), and specimen size [1.64 (SD 0.92) vs. 1.70 (SD 0.65), p=0.56). Conclusions No significant differences were found between the histological quality of the first biopsy and the sixth biopsy. Additional parameters such as specimen size, full thickness mucosa, absence of fragmentation and absence of crush artifact revealed no significant differences between the first and sixth biopsy. This preliminary data thus far shows that there is no difference between the histological quality when multiple biopsies are retrieved consecutively. Funding Agencies NoneNone

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