Diagnostic upper gastrointestinal endoscopy

Gershman, George; Thomson, Mike

doi:10.1002/9781119423492.ch11

Cited by 6 publications

(10 citation statements)

References 26 publications

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“…Age categories have been chosen statistically, to improve the correlation with the outcome, with the following procedure: we performed repeated linear regression between age and the outcomes (time to ileum and time to total procedure), dichotomizing the variable at subsequent age thresholds; then we chose the thresholds which provided the most predictive models and we used them to create the age groups. Consequently, age groups were (0, 3], (3)(4)(5), (5)(6)(7)(8)(9)(10)(11)(12)(13), (13)(14)(15), (15)(16)(17)(18)(19)(20), for time to ileum and (0-5], (5)(6)(7)(8)(9)(10)(11)(12)(13), (13)(14)(15), (15)(16)(17)(18)(19)(20), for time to total procedure (round brackets imply exclusion, square brackets inclusion of the values). Age groups were used either as linear predictors or for group to group comparisons.…”

Section: Discussionmentioning

confidence: 99%

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Sub‐10‐minute High‐quality Diagnostic Colonoscopy With Terminal Ileum Intubation in Children Is Feasible and Safe

Thomson

Eltumi

Singh

et al. 2019

J. pediatr. gastroenterol. nutr.

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Objectives: To critically appraise ileocolonoscopy practice in a large tertiary center, where ileocolonoscopy is exclusively performed by experienced pediatric colonoscopists, particularly focusing on: indications for the procedure; bowel preparation efficacy; IC completion rates and timings; diagnostic yield; and complications. Patients and methods:We prospectively evaluated all patients referred to our clinic between July 2015 and June 2016. Data on age, height and weight, gender, surgical history, indications for colonoscopy, bowel preparation given, bowel cleansing efficacy were collected. The following were calculated: percentage of terminal ileal intubation; time to terminal ileum; total duration of each procedure. Additionally, we evaluated the number and the type of complications encountered and the number of patients readmitted within 30 days from the elective procedure. Endoscopic diagnostic yield, stratified for indication, was calculated.Results: A total of 1392 patients were referred; 181 required an endoscopic evaluation of the lower GI tract (Outpatient Department conversion rate: 13%). Main indications for IC were: recurrent abdominal pain 38.1%; unexplained chronic diarrhea 16%; suspected IBD 24.9%; isolated rectal bleeding 13.2%; occult GI bleeding 1.6%; unexplained faltering growth 1.6%; IBD restaging 2.6%; miscellaneous 1.6%. Terminal ileum was reached in all the patients (TI intubation rate = 100%). Median time to TI was 9.8 minutes (1 to 50 minutes). Time to TI was lower in younger patients compared to older ones (p = 0.005). Bowel-cleansing was judged as: Grade 1 in 49.2%; Grade 2 in 33.7%; Grade 3 in 13.3%; and Grade 4 in 3.9%. A significant statistical correlation was recorded between bowel-cleansing and time to TI. The positive diagnostic yield was: 11.6% in patients with abdominal pain; 37.9% in patients with chronic diarrhea; 51.1% in patients with suspected IBD; 29.2% in patients with isolated rectal bleeding; 33.3% in patients with occult GI bleeding; 0% in patients with faltering growth; and 33% in the miscellaneous group. Conclusions:In conclusion, appropriately targeted IC in the management of children with GI symptoms, is a safe, fast and useful investigation. TI intubation rates of 100% are achievable and desirable and can be conducted quickly. Poor bowel preparation impacts negatively on this and IC duration may be faster in younger children. High diagnostic yields have been recorded in patients with a clinical suspicion of IBD. Diagnostic yield in isolated recurrent abdominal pain is low. Training to excellence in pediatric IC should be a persistent goal.

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Section: Discussionmentioning

confidence: 99%

“…Procedural duration was measured as actual endoscopy time not including time for anesthesia. All the endoscopists used the biopsy forceps as ''Seldinger'' type technique to intubate the terminal ileum (12). Scopes were generally advanced for 20 to 30 cm into the TI, or as far as safely possible.…”

Section: Methodsmentioning

confidence: 99%

Sub‐10‐minute High‐quality Diagnostic Colonoscopy With Terminal Ileum Intubation in Children Is Feasible and Safe

Thomson

Eltumi

Singh

et al. 2019

J. pediatr. gastroenterol. nutr.

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“…A detailed description of the technique of placement is out of the scope of this Guideline as it has been described in detail elsewhere and is an established procedure (37,38).…”

Section: Percutaneous Endoscopic Gastrostomy Techniquesmentioning

confidence: 99%

Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper

Homan

Hauser²,

Romano

et al. 2021

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Background: The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014. Methods: Asystematicreviewofmedicalliteraturefrom2014to2020wascarried out. Consensus on the content of the manuscript, including recommendations, was achievedbytheauthorsthroughelectronicandvirtualmeans.Theexpertopinionof the authors is also expressed in the manuscript when there was a lack of good scientific evidence regarding PEGs in children in the literature. Results: The authors recommend that the indication for a PEG be individualized, and that the decision for PEG insertion is arrived at by a multidisciplinary team (MDT) having considered all appropriate circumstances. Well timed enteral nutrition is optimal to treat faltering growth to avoid complications of malnutrition and body composition. Timing, device choice and method of insertion is dependent on the local expertise and after due consideration with the MDT and family. Major complications such as inadvertent bowel perforation should be avoided by attention to good technique and by ensuring the appropriate experience of the operating team. Feeding can be initiated as early as 3 hours after tube placement in a stable child with iso-osmolar feeds of standard polymeric formula. Low-profile devices can be inserted initially using the single-stage procedure or after 2-3 months by replacing a standard PEG tube, in those requiring longer-term feeding. Having had a period of non-use and reliance upon oral intake for growth and weight gain-typically 8-12 weeks-a PEG may then safely be removed after due consultation. In the event of non-closure of the fistula the most successful method for closing it, to date, has been a surgical procedure, but the Over-The-Scope-Clip (OTSC) has recently been used with considerable success in this scenario. Conclusions: A multidisciplinary approach is mandatory for the best possible treatment of children with PEGs. Morbidity and mortality are minimized through team decisions on indications for insertion, adequate planning and preparation before the procedure, subsequent monitoring of patients, timing of the change to low-profile devices, management of any complications, and optimal timing of removal of the PEG.

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“…In our hands-on training program, trainers advised the participants on the efficient usage of biopsy forceps, teaching them to slowly close the forceps cups while pushing the forceps with GS against the target by several millimeters. This technique, which enables the collection of large tissue samples in the forceps cups, has been explained as a tip for improving the adequacy of specimens obtained by biopsy forceps in some textbooks or papers on gastrointestinal endoscopy (23,24) and is also used by some bronchoscopists in clinical practice.…”

Section: (100%)mentioning

confidence: 99%

A novel biosimulator based on ex vivo porcine lungs for training in peripheral tissue sampling using endobronchial ultrasonography with a guide sheath

Ishiwata¹,

Nakajima²,

Terada³

2019

J. Thorac. Dis.

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Background: Although radial probe endobronchial ultrasonography (EBUS) with a guide sheath (GS; EBUS-GS) is widely used for sampling peripheral pulmonary lesions (PPLs), a standard training model for EBUS-GS remains to be developed. The purpose of this study was to evaluate the feasibility of a novel pulmonary biosimulator for hands-on training in peripheral tissue sampling using EBUS-GS Methods: We established a novel biosimulator for EBUS-GS using porcine lungs. The simulator was equipped with multiple pseudo PPLs that were created using blue agar solution injected through GS inserted in a bronchoscope. A total of 12 voluntary trainees participated in a hands-on training course using the biosimulator. The size of samples acquired using biopsy forceps were compared between initial and posttraining biopsies, and trainee satisfaction with the biosimulator and training program were evaluated using a questionnaire. Results: Under the guidance of a trainer, all trainees successfully detected pseudo PPLs using radial probe EBUS before the initial biopsy, and 11 trainees acquired samples from the target lesions during the initial biopsy. Post-training biopsy samples were larger than the initial samples for eight trainees. The results of the questionnaire revealed that all trainees were satisfied with the biosimulator. Moreover, eight trainees who had previously participated in another hands-on EBUS-GS training program involving a synthetic phantom model showed greater satisfaction for the biosimulator. Conclusions: A hands-on training program using the novel biosimulator assessed in this study could aid clinicians in improving their skills for EBUS-GS and acquiring larger peripheral tissue samples using biopsy forceps inserted through GS.

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Diagnostic upper gastrointestinal endoscopy

Cited by 6 publications

References 26 publications

Sub‐10‐minute High‐quality Diagnostic Colonoscopy With Terminal Ileum Intubation in Children Is Feasible and Safe

Sub‐10‐minute High‐quality Diagnostic Colonoscopy With Terminal Ileum Intubation in Children Is Feasible and Safe

Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper

A novel biosimulator based on ex vivo porcine lungs for training in peripheral tissue sampling using endobronchial ultrasonography with a guide sheath

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