Cap Assisted Upper Endoscopy for Examination of the Major Duodenal Papilla: A Randomized, Blinded, Controlled Crossover Study (CAPPA Study)

Abdelhafez, Mohamed; Phillip, Veit; Hapfelmeier, Alexander; Elnegouly, Mayada; Poszler, A; Strobel, K.; Born, Peter; Dollhopf, Markus; Kassem, Abdel Meguid; Calavrezos, Lenika; Klare, Peter; Schlag, Christoph; Bajbouj, Monther; Schmid, Roland M.; Delius, Stefan von

doi:10.1038/ajg.2017.47

Cited by 17 publications

(30 citation statements)

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“…In study 3, the MDP full visualization rate was 97% (98 out of 101 patients). In our study, the use of the biopsy forceps increased the MDP full visualization rate by 14%, reaching 604 of 671 patients examined (90%) (4) . The advantage demonstrated in our study is exactly the fact that our technique for MDP examination can be used in all patients submitted to conventional EGD with no previous history for MDP evaluation.…”

Section: Discussionmentioning

confidence: 57%

“…The MDP full visualization rate would then be really close to the values found in our study (76%) and in study 2 (80.8%). Only study 3 presented a very low MDP full visualization rate with conventional EGD (23.8%) (4) . The reasons for such difference in MDP visualization rates could lie in the professional performing those procedures, considering that only 44% of endoscopic examinations in study 3 were performed by ERCP-trained endoscopists.…”

Section: Discussionmentioning

confidence: 91%

“…However, the straightening maneuver has only enabled the full identification of MDP in 54.7% of patients studied, and the use of cap-fitted gastroscopes, while more efficient, is restricted to EGDs with the specific purpose of evaluating the MDP (1,4,5) . The ideal solution would be an easy and inexpensive method that could be used in all routine EGD, with high rates of MDP complete visualization.…”

Section: The Use Of the Forceps Biopsy As An Auxiliary Technique For mentioning

confidence: 99%

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The Use of the Forceps Biopsy as an Auxiliary Technique for the Visualization of the Major Duodenal Papilla Using the Foward-Viewing Upper Endoscopy

Andrade

André

Ferreira

et al. 2018

Arq. Gastroenterol.

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-Background -Conventional esophagogastroduodenoscopy is the best method for evaluation of the upper gastrointestinal tract, but it has limitations for the identification of the major duodenal papilla, even after the use of the straightening maneuver. Side-viewing duodenoscope is recommended for optimal examination of major duodenal papilla in patients at high risk for lesions in this region. Objective -To evaluate the use of the biopsy forceps during conventional esophagogastroduodenoscopy as an additional tool to the straightening maneuver, in the evaluation of the major duodenal papilla. Methods -A total of 671 patients were studied between 2013 and 2015, with active major duodenal papilla search in three endoscope steps: not straightened, straightened and use of the biopsy forceps after straightening. In all of them it was recorded whether: major duodenal papilla was fully visualized (position A), partially visualized (position B) or not visualized (position C). If major duodenal papilla was not fully visualized, patients continued to the next step. Results -A total of 341 were female (50.8%) with mean age of 49 years. Of the 671 patients, 324 (48.3%) major duodenal papilla was identified in position A, 112 (16.7%) in position B and 235 (35%) in position C. In the 347 patients who underwent the straightening maneuver, position A was found in 186 (53.6%), position B in 51 (14.7%) and position C in 110 (31.7%). Of the 161 remaining patients and after biopsy forceps use, position A was seen in 94 (58.4%), position B in 14 (8.7%) and position C in 53 (32.9%). The overall rate of complete visualization of major duodenal papilla was 90%. Conclusion -The use of the biopsy forceps significantly increased the total major duodenal papilla visualization rate by 14%, reaching 604/671 (90%) of the patients (P<0.01) and it can be easily incorporated into the routine endoscopic examination of the upper gastrointestinal tract.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 91%

Section: The Use Of the Forceps Biopsy As An Auxiliary Technique For mentioning

confidence: 99%

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The Use of the Forceps Biopsy as an Auxiliary Technique for the Visualization of the Major Duodenal Papilla Using the Foward-Viewing Upper Endoscopy

Andrade

André

Ferreira

et al. 2018

Arq. Gastroenterol.

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“…In the setting of haemodynamically stable hemobilia with no clear source of bleeding or significant vascular abnormalities on initial imaging, ERCP and upper endoscopy (with either a duodenoscope or a clear endcap‐outfitted gastroscope) are usually the procedures of choice given their ability to detect and manage both bleeding and biliary obstruction in a minimally invasive fashion …”

Section: Treatmentmentioning

confidence: 99%

Hemobilia: Historical overview, clinical update, and current practices

Zhornitskiy

Berry

Han

et al. 2019

Liver International

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Hemobilia refers to macroscopic blood in the lumen of the biliary tree. It represents an uncommon, but important, cause of gastrointestinal bleeding and can have potentially lethal sequelae if not promptly recognized and treated. The earliest known reports of hemobilia date to the 17th century, but due to the relative rarity and challenges in diagnosis of hemobilia, it has historically not been well‐studied. Until recently, most cases of hemobilia were due to trauma, but the majority now occur as a sequela of invasive procedures involving the hepatopancreatobiliary system. A triad (Quincke's) of right upper quadrant pain, jaundice and overt gastrointestinal bleeding has been classically described in hemobilia, but it is present in only a minority of patients. Therefore, prompt diagnosis depends critically on a high index of suspicion based on a patient's clinical presentation and a history of recently undergoing hepatopancreatobiliary intervention or having other predisposing factors. Treatment of hemobilia depends on the suspected source and clinical severity and thus ranges from supportive medical care to urgent advanced endoscopic, interventional radiologic, or surgical intervention. In the present review, we provide a historical perspective, clinical update and overview of current trends and practices pertaining to hemobilia.

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“…For hemodynamically stable hemobilia without clear arterial sources of bleeding or significant vascular abnormalities on noninvasive imaging, upper endoscopy (with a duodenoscope or a clear endcap-outfitted gastroscope) and ERCP are typically the initial therapeutic procedure of choice because of its utility in concurrently managing both bleeding and biliary obstruction [ 41 ].…”

Section: Managementmentioning

confidence: 99%

Hemobilia: Perspective and Role of the Advanced Endoscopist

Berry

Han

Girotra

et al. 2018

Gastroenterology Research and Practice

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Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon cause of gastrointestinal hemorrhage. Hemobilia has been documented since the 1600s, but due to its relative rarity, it has only been more critically examined in recent decades. Most cases of hemobilia are iatrogenic and caused by procedures involving the liver, pancreas, bile ducts, and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other major causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described, but this is present in only 25–30% of patients with hemobilia. Historically, the gold standard for diagnosis and treatment has been angiography and interventional radiologic intervention, respectively. However, the paradigm is shifting, at least in select cases, towards first-line reliance on noninvasive imaging (e.g., computed tomography) and therapeutic endoscopy, owing to advances in and the less invasive nature of both, while saving interventional radiological and/or surgical intervention for refractory or imminently life-threatening cases.

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Cap Assisted Upper Endoscopy for Examination of the Major Duodenal Papilla: A Randomized, Blinded, Controlled Crossover Study (CAPPA Study)

Abstract: CA-EGD enabled complete examination of MDP in almost all cases compared to a low success rate of S-EGD. CA-EGD detected a significant amount of lesions and incidental findings when added to S-EGD. CA-EGD is a safe and effective method for examination of MDP.

Cited by 17 publications

References 17 publications

The Use of the Forceps Biopsy as an Auxiliary Technique for the Visualization of the Major Duodenal Papilla Using the Foward-Viewing Upper Endoscopy

The Use of the Forceps Biopsy as an Auxiliary Technique for the Visualization of the Major Duodenal Papilla Using the Foward-Viewing Upper Endoscopy

Hemobilia: Historical overview, clinical update, and current practices

Hemobilia: Perspective and Role of the Advanced Endoscopist

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