The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation.

Background & Aims: Both unsedated transoral endoscopy (TOE) and sedated TOE have some drawbacks in clinical practice. Unsedated transnasal endoscopy (TNE) has been suggested as an alternative to both methods. This study aimed to determine the advantages of TNE in patients who have previously undergone unsedated conventional TOE.Methods: Patients who had received an unsedated TOE in the last 12 months and were scheduled for a second upper endoscopy were included. They were randomized to undergo either unsedated TOE, using a standard endoscope, or unsedated TNE, using an ultrathin endoscope. Post-procedure, patients were asked to complete a questionnaire to assess pain, discomfort and acceptability of the procedure, and to compare the current procedure with their previous unsedated TOE. Endoscope insertion rate, procedure duration, and side-effects were recorded.Results: Each group included 50 patients. With the exception of nasal pain, the tolerability and acceptance were significantly greater in the unsedated TNE group. Significantly more TNE patients (82%) found the current endoscopic procedure to be better than their previous TOE when compared with patients who had received a second TOE (12%). A repeat procedure was significantly more acceptable for TNE patients when compared to the TOE group (68% vs.16%). The duration of endoscopy was significantly shorter in TOE than in TNE (p<0.05). Endoscope insertion failed in 4% and mild epistaxis was observed in 4% of TNE patients.Conclusion: Unsedated TNE was better tolerated in endoscopy experienced patients when compared with unsedated TOE. The majority of patients found TNE more acceptable and preferable to TOE, suggesting that TNE should become a more common practice in clinics when applicable.

Introduction: Interventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential. Aim: To compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP. Material and methods: Forty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 µg/kg for 10 min) in group D. Propofol was used for maintenance. The sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded. Results: The hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 ±80.0 vs. 154.5 ±66.7 mg; p = 0.011). The recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 ±2.1 vs. 6.6 ±1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups. Conclusions: We found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients.

UTE is a useful tool for the evaluation of patients with advanced GI strictures. It provides a complete diagnostic endoscopy in most patients and gives an opportunity for therapeutic endoscopic procedures.

To the EditorEndoscopic retrograde cholangiopancreatography (ERCP) has become one of the most important techniques for diagnosis and treatment of choledocholithiasis. It is usually combined with sphincterotomy for the extraction of bile duct stones by using standard balloon or basket catheter, although papillary balloon dilatation has also been used in this setting. However, in approximately 10-15% of patients, bile duct stones are still present after the application of these standard extraction techniques. The most common etiology of unsuccessful applications is due to challenging access to the bile duct, large stone size ([15 mm in diameter), impacted stones in the bile duct, intrahepatic stones or cystic duct [1]. The presence of such factors restricting the ability to extract stones has led to the application of additional procedures for stone clearance. Mechanical lithotripsy, intraductal shock-wave lithotripsy, extracorporeal shock-wave lithotripsy, biliary stenting, and chemical dissolution are methods for removal of difficult stones. There are limited data regarding the effectiveness of these methods [2].In this study, we report extraction techniques for bile duct stones and the rate of endoscopic balloon dilatation of the patients who underwent ERCP in our department. A retrospective review of therapeutic ERCP was performed between 2003 and 2005 by using a database linked to the endoscopy reporting system.A series of 875 patients in our institute who underwent ERCP procedures was evaluated retrospectively. Common duct stones were identified in 316 patients (36.1%). In 292 (92.4%) of the 316 patients the stones were successfully removed by standard endoscopic sphincterotomy and balloon or basket extraction techniques. A total of five patients (1.6%) with large stones or stones at the distal side of biliary stenosis were treated by stent insertion. Mechanical lithotripsy was performed in 11 patients (3.5%). Dilatation with a large-diameter balloon was applied in the remaining eight patients (five females and three males; mean age 71.8 years) (2.5%) with large bile duct stones or limited sphincterotomy because of anatomical variants. Esophageal/pyloric/colonic wire-guided balloon dilatation catheters (Boston Scientific Microvasive, USA) were used; the diameters used 15-18 mm. After papillary balloon dilation, the stones were retrieved in seven patients. Bleeding (hemorrhage) occurred in only one case, in whom endoscopic dilation with a 18 mm diameter balloon for removal of bile duct stones had failed while extending endoscopic sphincterotomy and the patient was treated surgically.Ersoz et al. retrospectively reviewed the removal of bile duct stones by dilatation with a large-diameter balloon (10-20 mm) after adequate endoscopic sphincterotomy in 58 patients in whom standard basket/balloon extraction techniques had failed. In addition, results showed that I. Koruk

Background: Insulinoma is the most common endocrine tumor of the pancreas. Accurate preoperative detection and localization of insulinomas is essential for the appropriate selection of candidates for surgery. We present two cases with benign pancreatic insulinoma.

Intraoperative cholangioscopy with an ultrathin endoscope for hemobilia Fig. 1 Cholangioscopic view of the biliary system using an ultrathin endoscope showing: a the segment 7 bile duct (thin arrow) and the hemorrhagic segment 6 bile duct (wide arrow); b the normal left bile ducts. PTBD, percutaneous transhepatic biliary drainage catheter. Video 1Cholangioscopy of the normal left biliary system using an ultrathin endoscope. Video 2Cholangioscopy of the right biliary system using an ultrathin endoscope showing active bleeding. UCTN -Unusual cases and technical notes E410Aydinli M et al. Intraoperative cholangioscopy with ultrathin endoscope for hemobilia … Endoscopy 2011; 43: E410 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.