Empleo del modelo animal en la formación enendoscopia diagnóstica y terapéutica de la vía biliar / Animal model training in diagnostic and therapeutic biliary tract endoscopy teaching

Objetivo. Mostrar nuestra experiencia en la formación en endoscopia terapéutica de la vía biliar en modelo animal. Materiales y métodos. Esta actividad formativa tiene una duración de 13 horas y comienza iniciando al alumno en las diferencias anatómicas de las especies que se emplean, la porcina y la canina, con respecto a la anatomía humana. Las prácticas consisten en habituar al endoscopista a la visión lateral del duodenoscopio; se realizan en un modelo porcino debido a que es más sencillo atravesar el esfínter pilórico, aunque no suele ser muy adecuado para la canulación de la papila duodenal. Tras superar la primera fase se utiliza el modelo canino, que permite adquirir las habilidades y destrezas propias de esta técnica. La evaluación de los resultados se realiza mediante una encuesta anónima. Resultados. El 76% de los alumnos confirma que ha avanzado mucho con este entrenamiento, un 18% regular y un 6% poco. El 75% considera que, tras realizar esta actividad de formación, se encontraría capacitado para llevar a cabo la técnica en su hospital. El 94% de los alumnos recomendaría esta actividad a sus compañeros. Conclusiones. El empleo del modelo animal en la formación en colangio pancreatografía retrógada endoscópica (CPRE)permite la adquisición de habilidades básicas necesarias para la práctica, ya que posibilita la repetición de las maniobras y la tutela continuada. Consideramos que con esta metodología mixta se podría acortar la curva de aprendizaje de la CPRE y disminuiría la iatrogenia en las primeras fases (AU)

Aim. To show our experience in training in therapeutic endoscopy of the biliary tract in animal model. Materials and methods. This training activity has duration of 13 hours and starts initiating the trainee in anatomical differences with regard to human anatomy that occur between species that are used, the swine and canine. The practices consist of endoscopist to habituate the lateral view of duodenoscope, performing on pig model because it is easier to pass through the pyloricsphincter, although this is not very suitable for cannulation of the duodenal papilla. After passing the first stage, we used the canine model to acquire the skills and abilities specific to this technique. The performance evaluation is done through an anonymous survey. Results. 76% of students confirmed that they have made good progress with this training, 18% regular and 6% that shortly. 75% believed that after making this training would be found competent to carry out the technique in their hospitals. About 94% of students would recommend this activity. Conclusions. The use of animal model in training in endoscopic retrograde cholangiopancreatography (ERCP)permits the acquisition of basic skills needed for practice, a sit enables the repetition of the maneuvers and continuing care. We believe that this mixed methodology could shorten the learning curve for ERCP and reduce iatrogenic in the early stages (AU)

Use of sedation for routine diagnostic upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy Survey of National Endoscopy Society Members.

BACKGROUND/AIMS: Sedation rates may vary among countries, depending on patients' and endoscopists' preferences. The aim of this survey was to investigate the rate of using premedication for routine diagnostic upper gastrointestinal (UGI) endoscopy in endoscopy societies, members of the European Society of Gastrointestinal Endoscopy (ESGE). METHODS: We evaluated a multiple-choice questionnaire which was e-mailed to representatives of national endoscopy societies, which are members of the ESGE. The questionnaire had 14 items referring to endoscopy practices in each country and the representatives' endoscopy units. RESULTS: The response rate was 76% (34/45). In 47% of the countries, less than 25% of patients undergo routine diagnostic UGI endoscopy with conscious sedation. In 62% of the responders' endoscopy units, patients are not asked their preference for sedation and do not sign a consent form (59%). Common sedatives in use are midazolam (82%), diazepam (38%) or propofol (47%). Monitoring equipment is not available 'in most of the endoscopy units' in 46% (13/28) of the countries. Though they were available in 91% of the national representatives' endoscopy units, they are rarely (21%) used to monitor unsedated routine diagnostic UGI endoscopy. CONCLUSIONS: In about 50% of ESGE-related countries, less than 25% of patients are sedated for routine diagnostic UGI endoscopy. Major issues to improve include availability of monitoring equipment and the use of a consent form.

Detección preoperatoria de los tumores neuroendocrinos digestivos mediante ultrasonografía endoscópica / Preoperative detection of gastrointestinal neuroendocrine tumors using endoscopic ultrasonography

Objetivo: casi el 30% de los tumores neuroendocrinos gastroenteropancreáticos(TEGP) no pueden ser identificados preoperatoriamentemediante las técnicas habituales de diagnóstico por laimagen. El objetivo de este trabajo retrospectivo es presentarnuestra experiencia acumulada en la evaluación de los TEGP medianteultrasonografía endoscópica (USE) realizada antes de la cirugía,y compararla con una revisión de la literatura.Pacientes y métodos: treinta y siete enfermos con sospechade síndromes hormonales específicos fueron explorados correlativamentecon US, TC, RM, angiografía, Octreoscan y USE radialy sectorial. Dieciséis eran varones (43%) y 21 mujeres (57%) conuna edad media de 61 años (intervalo: 40-84 a). De los 37 pacientes,27 enfermos tenían 19 tumores endocrinos en el páncreasy 14 tumores en el tracto digestivo. En 10 pacientes no sedemostraron tumores por lo que se utilizaron como grupo control.De los 37 pacientes, 24 fueron operados o se obtuvo material histológico,confirmándose la existencia de 26 TEGP (10 carcinoides)en 22 pacientes.Resultados: la sensibilidad y precisión diagnóstica de la USE fuedel 81 y 78%. La especificidad fue del 80%. Todos estos valores fueronsimilares a la media obtenida en la revisión de la literatura.Se detectaron tres tumores pancreáticos menores o iguales a 1cm (insulinomas), que no habían sido diagnosticados anteriormentecon US, TC y RM.La exploración ecoendoscópica del páncreas no se pudo realizarcompletamente en dos casos (5%), un carcinoide pancreáticoy un doble gastrinoma pancreático que estaba gastrectomizado.Conclusión: la USE es una buena técnica preoperatoria de detecciónde los TEGP, y es posible que en la valoración de tumores depequeño tamaño y múltiples, supere a otras técnicas de imagen. Sepostula la utilidad de la USE como primera exploración tras la US oel TCH, para el diagnóstico y localización antes de la cirugía

Objective: almost 30% of gastroenteropancreatic neuroendocrinetumors (GEPET) escape preoperative identification usingstandard imaging techniques. The goal of this retrospective studyis to present our cumulative experience in the assessment ofGEPET by preoperative endoscopic ultrasonography (EUS), andto compare it with a literature review.Patients and methods: thirty-seven patients with suspectedspecific hormonal syndromes were sequentially examined withUS, CT, MRI, angiography, OctreoScan, and radial and sectorialEUS. Sixteen were males (43%) and 21 were females (57%), witha mean age of 61 years (interval: 40-84 a). Of all 37 patients, 27had 19 endocrine tumors in the pancreas and 14 tumors in theirgastrointestinal tract. No tumors were demonstrated in 10 patients,hence they were used as a control group. Of all 37 patients,24 were operated on or had histological samples collected,with the presence of 26 GEPET (10 carcinoids) being confirmedin 22 patients.Results: EUS sensitivity and diagnostic accuracy were 81%and 78%. Specificity was 80%. All these values were similar to themean values obtained from the literature review.Three pancreatic rumors smaller than or equal to 1 cm (insulinomas)were detected, which had escaped diagnosis with previousUS, CT, and MRI studies.An echoendoscopic examination of the pancreas could not becompleted in two cases (5%), a pancreas carcinoid and an alreadygastrectomized double pancreatic gastrinoma.Conclusion: EUS is a good preoperative technique forGEPET detection, and may likely be superior to other imagingtechniques in the assessment of small tumors. The usefulness ofEUS as a primary exploration after US or HCT has been positedfor tumor diagnosis and localization before surgery

Preoperative detection of gastrointestinal neuroendocrine tumors using endoscopic ultrasonography.

OBJECTIVE: Almost 30% of gastroenteropancreatic neuroendocrine tumors (GEPET) escape preoperative identification using standard imaging techniques. The goal of this retrospective study is to present our cumulative experience in the assessment of GEPET by preoperative endoscopic ultrasonography (EUS), and to compare it with a literature review. PATIENTS AND METHODS: Thirty-seven patients with suspected specific hormonal syndromes were sequentially examined with US, CT, MRI, angiography, OctreoScan, and radial and sectorial EUS. Sixteen were males (43%) and 21 were females (57%), with a mean age of 61 years (interval: 40-84 a). Of all 37 patients, 27 had 19 endocrine tumors in the pancreas and 14 tumors in their gastrointestinal tract. No tumors were demonstrated in 10 patients, hence they were used as a control group. Of all 37 patients, 24 were operated on or had histological samples collected, with the presence of 26 GEPET (10 carcinoids) being confirmed in 22 patients. RESULTS: EUS sensitivity and diagnostic accuracy were 81% and 78%. Specificity was 80%. All these values were similar to the mean values obtained from the literature review. Three pancreatic rumors smaller than or equal to 1 cm (insulinomas) were detected, which had escaped diagnosis with previous US, CT, and MRI studies. An echoendoscopic examination of the pancreas could not be completed in two cases (5%), a pancreas carcinoid and an already gastrectomized double pancreatic gastrinoma. CONCLUSION: EUS is a good preoperative technique for GEPET detection, and may likely be superior to other imaging techniques in the assessment of small tumors. The usefulness of EUS as a primary exploration after US or HCT has been posited for tumor diagnosis and localization before surgery.

[The diagnosis and preoperative location of digestive endocrine tumors by endoscopic ultrasonography]. / Diagnóstico y localización preoperatoria de los tumores endocrinos digestivos mediante ultrasonografía endoscópica.

UNLABELLED: Around 30% of the gastroenteropancreatic endocrine tumors (GPET) cannot be preoperatively identified by the common diagnostic imaging techniques. The aim of this retrospective study was to present our experience in the diagnosis and localization of GPET by endoscopic ultrasonography (EUS) performed prior to surgery and compare this with a review of the literature. PATIENTS AND METHODS: Twenty patients suspected of having specific hormonal syndromes were correlatively explored with US, CT, MR, angiography, octreoscan and radial EUS with Olympus GFUM3/EUM3 and GF-UM20/EUM 20 and 30. Eleven cases were males (55%) and 9 (45%) females with a mean age of 60 years (range: 40-80 years). Of the 20 patients, 14 had endocrine 16 tumors in the pancreas and 6 tumors in the gastrointestinal tract. In 6 patients no tumors were found and were therefore used as a control group. Of the 20 patients, 14 underwent surgery confirming the existence of GPET in 12 cases. RESULTS: The diagnostic sensitivity and precision of the EUS were of 75 and 78%, respectively, with these percentages being higher to those obtained with other imaging techniques. The specificity was 83%. All these values were slightly lower than the mean obtained on review of the literature. Two pancreatic tumors of less than or equal to 1 cm were detected which had not been previously diagnosed with US, CT and MR. In two cases the exact situation was not determined. Echo-endoscopic exploration of the pancrease could not be completely performed in two cases (10%), one pancreatic carcinoma and one double pancreatic gastrinoma which was gastrectomized. Endoscopic ultrasonography is a good preoperative technique for detecting GPET and in the evaluation of small sized tumors it may surpass other imaging techniques. The usefulness of EUS as a second exploration following US has been suggested for the diagnosis and localization prior to surgery.