Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study

Abstract

Background and aimsBetween 10 and 20% of all patients undergoing bariatric surgery procedures regain weight secondary to a gastrojejunostomy enlargement. The aim of this study was to validate the interobserver agreement while measuring gastric outlet diameters using a new standard guidewire.MethodsWe selected thirty-five videos of consecutive endoscopic procedures on patients undergoing esophagogastroduodenoscopy after a Roux-en-Y gastric bypass procedure. All videos were evaluated by four raters: two expert endoscopists and two trainees. We excluded videos having a slipped Fobi ring or a strictured gastric outlet. Anastomosis diameter was measured using a novel device with standardized markings on a guidewire (Hydra jagwire, Boston Scientific, Natick. MA) as well as the current gold standard defined as a calibrated endoscopic measuring instrument (Olympus America, Center Valley, PA).ResultsWe obtained 272 measurements of the gastric outlet. Overall agreement measured through intra-class correlation coefficients for the gold standard was 0.84 (p < 0.01) and 0.83 (p < 0.01) for the new guidewire. Agreement among experts was 0.699 (p < 0.01), while among trainees it was 0.822 (p < 0.01).ConclusionThe new guidewire demonstrated a high degree of observer reliability, also presenting similar results between expert endoscopists and trainees.

Level of glycemic control and its associated factors among type II diabetic patients in debre tabor general hospital, northwest Ethiopia

“…Diabetic patients who can read and write, learned primary school, and achieve college and above were 3, 4 and 5.7 times more likely to have good glycemic control respectively as compared with those who couldn’t read and write. The finding of this study is consistent with the study conducted at Dessie Referral Hospital, Jimma University Teaching Hospital, and Shenen Gibie Hospital [ 20 , 21 , 30 , 39 ]. The reason may be due to educational status’s effect on patient’s adherence to medical recommendations.…”

“…On the other hand, it is below than the study conducted at Tikur Anbessa Hospital (80%), South Africa (83.8%), Kenya (81.6%), India (91.8%), and Palestine (80.5%) [ [33] , [34] , [35] , [36] , [37] ]. On the other hand, it is higher than the study done at Zambia (61.3%), Limmu Genet Hospital (63.8%), Suhul Hospital (63.5%), Nigeria (55%), Ayider Specialized hospital (48.7%) and Shenen Gibe Hospital (59.2%) [ 21 , [38] , [39] , [40] , [41] , [42] ]. The possible justification for the discrepancy may be due to the difference in the quality of care given for the patients at each hospital that the study done and the method used to assess the glycemic level.…”

“…Despite, of the importance of good glycemic control, evidences showed that there is poor glycemic control in Ethiopia [ [17] , [18] , [19] , [20] ]. Different studies evidenced that being unable to read and write, farmer, having poor medication adherence [ 20 ], duration with diabetics [ 12 , 21 , 22 ], and duration of diabetics treatment [ 21 ] were the significant associated factors for poor glycemic control among type 2 diabetic patients. This study was aimed to assess the level of glycemic control and its associated factors among type 2 diabetic patients who had a follow up at Debre Tabor General Hospital, Northwest Ethiopia.…”

Good Clinical Practices on Argon Plasma Coagulation Treatment for Weight Regain Associated with Dilated Gastrojejunostomy Following Roux-en-Y Gastric Bypass: a Brazilian-Modified Delphi Consensus

“…The assessment of the anastomotic diameter is also challenging since the gold standard method—the endoscopic ruler—is not commercially available anymore. Interestingly, de Quadros et al validated an alternative technique using a guidewire marked each 5 mm [ 31 ]. That is a cost-effective and straightforward method that may be routinely employed since guidewires are broadly available and all endoscopists are familiar with them.…”