Effects of basic endoscopic handling and care training on gastrointestinal endoscopy logistics.

Background and study aims The current practice of endoscopists is undergoing a dramatic revolution due to emerging endoscopy practices. Increasing use of gastrointestinal endoscopy has led to hospital budgets setting aside funds specifically related to damage to endoscopic instruments. Therefore, training in understanding endoscopic equipment, handling techniques, and equipment care can be helpful in addressing this issue. The aim of this study was to investigate the effects of educational courses and training about basic endoscopic handling and care in gastrointestinal endoscopic care and services. Methods A number of new endoscopists, nurses, and nurse assistants were enrolled in a course for training in basic endoscopic handling and care. Data on the type of damage, cause, cost, and timing of endoscopic repair were prospectively collected. Data from the post-training period then were compared with retrospective data from the pre-training period. Results This study demonstrated that after training, there was less damage to endoscopes, lower costs associated with it, and repair times were shorter for endoscopes than before the training course. Post-training results indicated savings of a total of $ 40,617.21 or £â€Š29,539.78 and 102.6 days per damaged endoscope. Conclusions Basic endoscopic handling and care training plays an important role for both endoscopists and nurses, as well as in endoscopy facilities, specifically in avoiding the nuisance of unwanted and broken endoscopes. This could be beneficial for both hospital finances and endoscopic services.

Gastrostomy in Patients with Previous Abdominal Surgery: A Comparative Study Between the Laparoscopy-Assisted Introducer Percutaneous Endoscopic Gastrostomy Versus Open Gastrostomy in Advanced Esophageal Cancer.

Straightened nutritional status plays a vital role in the treatment outcome of advanced esophageal cancer. Both introducer percutaneous endoscopic gastrostomy (PEG) and open gastrostomy are safe options with avoidance risk of cancer cell seeding. The introducer PEG is an effective minimally invasive procedure with few complications, but the procedural method faces limitations for patients with a history of previous abdominal surgery. This study set out to compare the results of laparoscopy-assisted introducer PEG (LAIPEG) with open gastrostomy in advanced esophageal cancer patients with previous abdominal surgery. The advanced esophageal cancer patients who had previous abdominal surgery and indicated an enteral feeding tube between January 2014 and September 2019, were respectively analyzed. The open gastrostomy group was 35 patients, and the LAIPEG group was 18 patients. Operative duration, blood loss, postoperative pain score, and hospitalization time were significantly less in the LAIPEG group. Related procedural complications occurred only in the open gastrostomy group. Both groups are discharged from the hospital without readmission or 30-day mortality. Both procedures are safe options for advanced esophageal cancer patients with previous abdominal surgery for enteral feeding nutrition while minimizing the risk of cancer seeding. The LAIPEG demonstrated an effective minimally invasive procedure, which is safe with fewer complications. Previous surgery of the left supramesocolic area may be legitimate concerns before choosing introducer PEG for esophageal cancer with a history of prior surgery.

Comparison of Introducer Percutaneous Endoscopic Gastrostomy with Open Gastrostomy in Advanced Esophageal Cancer Patients.

In esophageal cancer treatment, nutrition by feeding tube has been demonstrated to improve patient tolerance of treatment, quality of life, and long-term outcomes. The open gastrostomy and percutaneous endoscopic gastrostomy (PEG) using introducer technique are procedures that avoid cancer cells seeding and also improve patient's nutritional status, hydration, and medication. The aim of this study is to compare the results of the introducer PEG and open gastrostomy in patients with advanced esophageal cancer. A retrospective study was analyzed in the advanced esophageal cancer patients who indicated and received feeding support between January 2016 and December 2017. Twenty-eight patients in introducer PEG and 36 patients in open gastrostomy presented the following comparative data: mean operative duration time shorter, less pain score, and shorter hospitalization in introducer PEG than open gastrostomy. Both groups showed no readmission or 30-day mortality. The adverse events of open gastrostomy demonstrated higher than introducer PEG group. Both introducer PEG and open gastrostomy were the safe options for advanced esophageal cancer patients indicating for enteral feeding and to avoid cancer cell seeding but the introducer PEG demonstrated the effective minimally invasive procedure with fewer complications.

Cost-Effectiveness Evaluation of Bariatric Surgery for Morbidly Obese with Diabetes Patients in Thailand.

Background: Bariatric surgery is a choice for treatment in morbidly obese patients with type 2 diabetes mellitus (DM type 2) who have inadequate diabetes control with only medical treatment. However, bariatric surgery requires highly sophisticated equipment, and thus the cost of surgery seems to be very high following the procedure compared with the cost of conventional diabetes care. This raises the question of whether bariatric surgery is cost-effective for morbidly obese people with diabetes in Thailand. Objective: To perform a cost-effectiveness evaluation of bariatric surgery compared with ordinary treatment for diabetes control in morbidly obese DM type 2 patients in Thailand. Methods: Cost-effectiveness study was conducted, using a combination of decision tree and Markov model in analysis. Treatment outcomes and healthcare costs were incurred by data from literature review and retrospective cohort in King Chulalongkorn Memorial Hospital from September 2009 to March 2016 for the conventional and bariatric surgery group, respectively. One-way sensitivity was used for analysis of the robustness of the model. Cost-effectiveness was assessed by calculating incremental cost-effectiveness ratios (ICERs). Monetary benefits at a threshold of 150,000 to 200,000 Thai baht (THB) per quality-adjusted life-year (QALY) based on the Thailand gross domestic products (GDP) value was regarded as cost-effectiveness of bariatric surgery. Results: Bariatric surgery significantly improves the clinical outcome including long-term diabetes remission rate, hemoglobin A1C, and body mass index (BMI). The incremental cost per QALY of bariatric surgery compared with the medication control is 26,907.76 THB/QALY which can consider bariatric surgery as a cost-effective option. Conclusions: Use of bariatric surgery in morbidly obese with DM type 2 patients is a cost-effective strategy in Thailand's context.

Non-exposed endoscopic wall-inversion surgery for a gastrointestinal stromal tumor of the stomach: A case report.

Complete surgical resections are crucial for permanently curing patients with gastrointestinal stromal tumors (GISTs). Laparoscopic wedge resection is a widely accepted surgical treatment, but identifying the tumor margin from a serosal laparoscopic view is challenging when using this technique. Non-exposed endoscopic wall-inversion surgery (NEWS) for patients with gastric GISTs is a novel, minimally invasive surgical technique that may aid in complete resection of the tumor margin by endoscopy and laparoscopy methods, removing the whole layer of the gastric wall and the entire tumor, with decreased risk of peritoneal contamination or tumor spread to the peritoneum. To the best of our knowledge, the present study reports the first use of NEWS for a patient with small gastric GIST in Thailand. A 61-year old female presented with jaundice and was diagnosed with acute viral hepatitis A. At 4 months, the severity of the symptoms had decreased but the serum transaminase in the liver function tests remained elevated. The computed tomography scans incidentally demonstrated a gastric mass that protruded into the lumen. Endoscopic examination revealed a 2.5×2.0-cm sub-epithelial tumor located in the posterior wall of the upper gastric body. The patient was informed and consented to undergo NEWS. No intraoperative or immediate postoperative complications were detected. The patient was discharged 5 days following the surgery. In a follow-up visit 4 weeks subsequent to the surgery, the patient was healthy and without complications.