Early experience with unsedated ultrathin 4.9 mm transnasal gastroscopy: a pilot study.

BACKGROUND: Unsedated transnasal gastroscopy is a technique with unverified clinical advantages. OBJECTIVE: To evaluate the efficacy and procedure times with transnasal gastroscopy by physicians with no previous experience in transnasal endoscopy. METHODS: Unsedated transnasal gastroscopy using 4.9 mm ultrathin transnasal gastroscopes with randomization to two different biopsy forceps was prospectively evaluated during a single day in January 2008. The outcomes included patient tolerance (scale: 1, no discomfort; 10, severe discomfort), physician technical assessment (1, excellent; 10, very poor), gastric biopsy quality, adverse events and procedure times. RESULTS: Twenty patients underwent transnasal gastroscopy. Nineteen patients (95%) successfully completed transnasal gastroscopy. The patient-reported mean (+/- SD) overall discomfort level during the procedure was 4.0+/-1.9 compared with a physician-estimated level of 3.2+/-1.7 (P=0.04). Only 10% (n=2) reported they would have preferred sedated over unsedated gastroscopy. Mean total encounter time from anesthesia to discharge was 33.5+/-9.3 min. The time from anesthesia to insertion was 7.0+/-5.3 min and from room exit to discharge 6.2+/-2.9 min. No patients who had gastric biopsies taken (zero of 14) had any of unacceptable quality. The only adverse event was distressing sensations (dyspnea, dizziness) in one patient that started during pre-endoscopy anesthetic application, persisting postendoscopy, but without any abnormalities in vital signs. CONCLUSION: Assuming the adverse event was a rare reaction, early experience with unsedated ultrathin transnasal gastroscopy was an efficient, effective and well-tolerated procedure for evaluation of the upper gastrointestinal tract.

Routine colonoscopy with a standard gastroscope. A randomized comparative trial in a western population.

BACKGROUND AND AIMS: Colorectal cancer screening increased the workload of colonoscopic procedures in endoscopic units. Recent developments advocated the use of smaller and more flexible scopes to achieve the goal of a complete examination to the cecum. Therefore, the use of an upper GI scope for colonoscopy can be considered. MATERIALS AND METHODS: Six-hundred and fifty consecutive patients (age, 64 +/- 20 years, 395 women) undergoing routine colonoscopy were examined with either a standard colonoscope or an upper GI scope in randomized order. In case of an incomplete examination, colonoscopy was repeated with the alternative instrument in the same session. All patients underwent bowel preparation with 4 1 of a polyethylene glycol solution, and the examinations were performed under conscious sedation (midazolam and pethidine i.v.) by a single investigator. RESULTS: Because of insufficient colonic preparation or refusal to participate, 28 patients had to be excluded. Both groups (colonoscope group, n = 315, upper GI scope group, n = 307) were well comparable with respect to their demographic data, previous abdominal surgery, the presence of diverticulosis, and the number of former colonoscopic examinations, respectively. Successful cecum intubation was achieved in 96% of the cases in the colonoscope group and in 93% of the patients from the upper GI scope group (p = 0.82). However, the time until the cecum was reached was prolonged to 8.7 +/- 2.4 min when using the upper GI scope compared with 8.2 +/- 2.3 min in the colonoscope group (p = 0.006). In the colonoscope group, a switch to the upper GI scope enables a complete colonoscopy in all but three cases (11/14, 79%) whereas this aim was only achieved vice versa in the upper GI scope group (using a colonoscope) in 7 of 21 patients (33%, p = 0.04). CONCLUSION: Routine colonoscopy can be performed effectively with standard upper GI scopes in a western population if no colonoscope is available.

[FTIR spectroscopic study on gastric tissue samples from gastroscopy].

A total of 184 specimens from gastroscopy were studied using Fourier transform infrared (FTIR) spectroscopy. The spectra of small-sized gastric endoscope samples with high quality were measured using the modified FTIR spectrometer with a MCT detector. The results show that the spectra of chronic superficial gastritis are similar to those of the normal block tissue in our previous study. But there are significant differences in band location and relative intensity between the spectra of chronic superficial gastritis and those of normal gastric tissues. Similarly, the differences exist in the spectra of chronic atrophic gastritis and those of malignant gastric tissues. In addition, the subtraction technique can provide more information to identify well the gastric samples of chronic atrophic gastritis, superficial gastritis and gastric cancer from endoscope the detection. These results indicate that FTIR spectroscopy exhibits potential to diagnose the gastric samples from gastroscopy.

[Disposable versus reusable biopsy forceps. A prospective cost analysis in the gastrointestinal endoscopy unit of the Dijon University Hospital]. / Pinces à biopsie jetables versus réutilisables. Evaluation économique prospective dan l'unité d'endoscopic digestive du CHU de Dijon.

AIMS: The goal of this study was to compare the cost of a biopsy session performed with a disposable and a reusable endoscopic biopsy forceps. MATERIAL AND METHODS: Over a 10-month period, 15 new reusable forceps (10 gastric and 5 colonic) were prospectively tracked. A biopsy session performed with a reusable forceps included its current purchase price, the sterilization cost and the number of uses. A biopsy session performed with a disposable forceps was calculated with its current purchase price and its incineration cost. RESULTS: At the end of the study, only one reusable forceps had broken and the number of uses was 65. The cost of a biopsy session performed with a gastric reusable forceps was euro 7.52 (including euro 1.92 of sterilization cost) and euro 8.67 for a reusable colonic forceps (with the same sterilization cost). The cost of a biopsy session performed with a gastric or a colonic disposable forceps was euro 11.98. From 44 uses for a colonic forceps and 37 uses for a gastric one, a biopsy session performed with a reusable forceps was already cheaper. CONCLUSION: In this study, a biopsy session performed with a reusable forceps was less expensive than with a disposable one. However, the extra cost generated by the disposable forceps may be offset by an easier inventory control and the reduction of the cross contamination risk.