Direct peroral cholangioscopy using an ultrathin endoscope: making technique easier.

BACKGROUND: Cholangioscopy is a useful tool for the study and treatment of biliary pathology. Ultrathin upper endoscopes allow direct peroral cholangioscopy (DPC) but have some drawbacks. OBJECTIVE: The aim of the study was to evaluate the success rate of DPC with an ultrathin endoscope using a balloon catheter to reach the biliary confluence. MATERIAL AND METHODS: Prospective observational study. An ultrathin endoscope (Olympus XP180N, outer diameter 5.5 mm, working channel 2 mm) was used. To access the biliary tree, free-hand technique was used. To reach the biliary confluence an intraductal balloon catheter (Olympus B5-2Q diameter 1.9 mm) and a 0.025 inch guide wire was used. In all cases sphincterotomy and/or sphincteroplasty was performed. The success rate was defined as the percentage of cases in which the biliary confluence could be reached with the ultrathin endoscope. RESULTS: Fifteen patients (8 men/7 women) were included. Mean age was 77.7 + or - 10.8 years (range 45-91). The indications for cholangioscopy were suspected bile duct stones (n = 9), electrohydraulic lithotripsy for the treatment of difficult choledocholithiasis (n = 5) and evaluation of biliary stricture (n = 1). Access to the bile duct was achieved in 14/15 cases (93.3%). Biliary confluence was reached in 13/15 cases (86.7%). One complication was observed in one patient (oxigen desaturation). CONCLUSIONS: DPC with an ultrathin endoscope can be done with the free-hand technique. Intraductal balloon-guided DPC allows full examination of the common bile duct in most cases.

Does "responsive insertion technology" improve practice of colonoscopy? Results of a randomized study.

OBJECTIVE. During colonoscopy, advancing the endoscope can sometimes be difficult due to the appearance of loops or bends in the insertion tube. Therefore, research continues toward improving colonoscope technology. The aim of this study is to compare the use of colonoscopes equipped with "responsive insertion technology" (RIT) versus regular non-RIT colonoscopes. MATERIALS AND METHODS. Prospective, comparative and randomized trials that included patients submitted to colonoscopy. In group I, RIT colonoscopes were used, while in group II, colonoscopies with variable stiffness but without the other components of the RIT technology were used. Demographic variables and variables related to colonoscopy, as well as the pain perceived by the patient and the difficulty in performing endoscopy were recorded. RESULTS. A total of 122 patients were included in group I and 120 patients in group II. The cecal intubation rate was similar in both groups. The use of the RIT colonoscopes was associated with a lower cecal intubation time (4.4 ± 2.0 vs. 5.4 ± 3.5, p = 0.005) and a lower difficulty in performing examinations for both the endoscopist (19.1 ± 20.0 vs. 27.7 ± 22.2, p = 0.002) and the nursing staff (20.8 ± 17.0 vs. 26.3 ± 19.6, p = 0.04). No significant differences were found between both groups in the need for ancillary maneuvers or in the pain perceived by the patient. CONCLUSIONS. RIT colonoscopes allow cecal intubation in a shorter time compared to variable stiffness colonoscopes, and are associated with a greater level of ease of the procedure.

Colangioscopia peroral directa con endoscopios ultrafinos: haciendo más simple la técnica / Direct peroral cholangioscopy using an ultrathin endoscope: making technique easier

Introducción: la colangioscopia es una técnica muy útil para el estudio y tratamiento de la patología biliar. Los endoscopios ultrafinos permiten realizar la colangioscopia peroral directa (CPOD) pero presentan algunos inconvenientes. Objetivo: el objetivo del estudio fue evaluar la eficacia de la CPOD con endoscopio ultrafino, accediendo a la vía biliar con la técnica de manos libres y utilizando un balón intraductal para alcanzar la confluencia biliar. Material y métodos: estudio observacional prospectivo. Se utilizó un endoscopio ultrafino (Olympus XP180N, diámetro externo 5,5 mm, canal trabajo 2 mm). Para avanzar el endoscopio hasta la confluencia biliar se utilizó un balón intraductal (Olympus B5-2Q diámetro 1,9 mm), sobre guía de 0,025 pulgadas. Se realizó en todos los casos papilotomía y/o papiloplastia. La eficacia de la CPOD se valoró por el porcentaje de casos en que se alcanzó la confluencia biliar. Resultados: se incluyeron 15 pacientes (8 hombres / 7 mujeres). La edad media fue de 77,7 ± 10,8 años (rango 45-91). Las indicaciones para la colangioscopia fueron: sospecha de cálculos de vía biliar (n = 9), tratamiento de coledocolitiasis difíciles mediante litotricia electrohidráulica (n = 5) y evaluación estenosis biliar (n = 1). Se accedió a la vía biliar en 14/15 casos (93,3 %). Se alcanzó la confluencia biliar en 13/15 casos (86,7 %). Se observó una complicación en un paciente (desaturación). Conclusiones: la CPOD con endoscopio ultrafino puede realizarse con técnica de manos libres, consiguiendo, apoyada por el balón intraductal, la exploración completa de la vía biliar principal en la mayoría de los casos (AU)

Background: Cholangioscopy is a useful tool for the study and treatment of biliary pathology. Ultrathin upper endoscopes allow direct peroral cholangioscopy (DPC) but have some drawbacks. Objective: The aim of the study was to evaluate the success rate of DPC with an ultrathin endoscope using a balloon catheter to reach the biliary confluence. Material and methods: Prospective observational study. An ultrathin endoscope (Olympus XP180N, outer diameter 5.5 mm, working channel 2 mm) was used. To access the biliary tree, free-hand technique was used. To reach the biliary confluence an intraductal balloon catheter (Olympus B5-2Q diameter 1.9 mm) and a 0.025 inch guide wire was used. In all cases sphincterotomy and/ or sphincteroplasty was performed. The success rate was defined as the percentage of cases in which the biliary confluence could be reached with the ultrathin endoscope. Results: Fifteen patients (8 men/7 women) were included. Mean age was 77.7 ± 10.8 years (range 45-91). The indications for cholangioscopy were suspected bile duct stones (n = 9), electrohydraulic lithotripsy for the treatment of difficult choledocholithiasis (n = 5) and evaluation of biliary stricture (n = 1). Access to the bile duct was achieved in 14/15 cases (93.3 %). Biliary confluence was reached in 13/15 cases (86.7 %). One complication was observed in one patient (oxigen desaturation). Conclusions: DPC with an ultrathin endoscope can be done with the free-hand technique. Intraductal balloon-guided DPC allows full examination of the common bile duct in most cases (AU)

Factors associated with non-attendance at outpatient endoscopy.

OBJECTIVE: Non-attendance at endoscopy procedures leads to wasted resources and increased costs. The purpose of this study was to investigate the factors associated with non-attendance. MATERIAL AND METHODS: All patients who attended the outpatient clinic for gastroscopy or colonoscopy examinations were included in the study. Patients who missed their appointment were identified and their data were collected prospectively. Patients who kept their appointment in the same period of time served as controls. RESULTS: Between August 2002 and February 2003, 1051 gastroscopies and 756 colonoscopies were scheduled. A total of 265 patients (14.7%) missed their appointment. No significant differences were found between attendees and non-attendees for mean age, gender, type of examination and day of the week on which the examination was scheduled. The time on the waiting list was longer in patients who did not keep their appointment than in those who did. Fewer appointments were missed in patients with a preferent referral, and among patients referred by their general practitioner a higher percentage failed to keep their appointment compared with those referred by a specialist. In the multivariate analysis, length of time on the waiting list and the source of referral were the only two independent predictive factors for non-attendance. CONCLUSIONS: A longer time on the waiting list and referral by a general practitioner are factors associated with patients failing to keep their endoscopy appointment.