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October 20-24, 2012 – 20^thUnited European Gastroenterology Week (UEGW)

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Endoscopist-directed propofol administration versus anesthesiologist assistance for colorectal cancer screening: a cost–effectiveness analysis (FREE ACCESS)
C. Hassan, D. K. Rex, G. S. Cooper, R. Benamouzig

This cost–effectiveness analysis compares endoscopist-directed and anesthetist-assisted propofol sedation in populations in the United States and Europe. In a base-case scenario, cost savings for endoscopist-directed sedation would be substantial (US $3.2 billion and France €0.8 billion, over 10 years). Even when a minimal mortality with endoscopist-directed propofol sedation is considered in a sensitivity analysis, anesthetist-assisted sedation would cost $1.5 million per life-year gained – far beyond the accepted societal threshold of cost-effective care.

Withdrawal time as a quality indicator for colonoscopy – a nationwide analysis (FREE ACCESS)
V. Moritz, M. Bretthauer, H. K. Ruud, T. Glomsaker, T. de Lange, P. Sandvei, G. Huppertz-Hauss, Ø. Kjellevold, G. Hoff

The value of withdrawal time as a colonoscopy quality indicator was explored in a nationwide analysis (19 Norwegian centers). Withdrawal time using 6 minutes as the threshold was not found to be a strong predictor of polyp detection. The adjusted odds ratio for the detection of polyps ≥5 mm was 1.21 (95%CI 0.94–1.56, P= 0.14) when comparing endoscopists with median withdrawal times of at least 6 minutes and less than 6 minutes.

Transgastric endoscopic gastroenterostomy using a partially covered occluder – a canine feasibility study (FREE ACCESS)
H. Luo, Y. Pan, L. Min, L. Zhao, J. Li, J. Leung, L. Xue, Z. Yin, X. Liu, Z. Liu, A. Sun, C. Li, K. Wu, X. Guo, D. Fan

A novel method of creating a gastroenterostomy using natural orifice transluminal endoscopic surgery (NOTES) with an occluder was reported. The technique was investigated in 12 healthy female dogs using a therapeutic upper gastrointestinal endoscope and a partially covered occluder, which was removed 1 week later. Placement was technically successful without anastomotic leakage or intestinal obstruction, and with complete healing of the anastomosis on histological evaluation. Although the outcomes were very promising, confirmation in a human study is needed.

Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline (FREE ACCESS)
C. Spada, C. Hassan, J. P. Galmiche, H. Neuhaus, J. M. Dumonceau, S. Adler, O. Epstein, G. Gay, M. Pennazio, D. K. Rex, R. Benamouzig, R. de Franchis, M. Delvaux, J. Devière, R. Eliakim, C. Fraser, F. Hagenmuller, J. M. Herrerias, M. Keuchel, F. Macrae, M. Munoz-Navas, T. Ponchon, E. Quintero, M. E. Riccioni, E. Rondonotti, R. Marmo, J. J. Sung, H. Tajiri, E. Toth, K. Triantafyllou, A. Van Gossum, G. Costamagna

PillCam colon capsule endoscopy (CCE) is an innovative noninvasive, and painless ingestible capsule technique that allows exploration of the colon without the need for sedation and gas insufflation. Although it is already available in European and other countries, the clinical indications for CCE as well as the reporting and work-up of findings from the procedure have not yet been standardized. The aim of this evidence-based and consensus-based guideline, commissioned by the European Society of Gastrointestinal Endoscopy (ESGE) is to furnish healthcare providers with a comprehensive framework for potential implementation of this technique in a clinical setting.

UEGW 2011 Report: Putting endoscopy into perspective (FREE ACCESS)

I. S. Papanikolaou, T. Rösch

The 19th United European Gastroenterology Week (22–26 October 2011; Stockholm, Sweden) presented a unique opportunity for delegates interested in gastrointestinal endoscopy to update their knowledge as colleagues from around the world shared their experiences. This report focuses on oral presentations and selected poster presentations and aims to review them in the light of recent literature.

Image Gallery

A pilot study evaluating a new low-volume colon cleansing procedure for capsule colonoscopy

D. Hartmann, M. Keuchel, M. Philipper, I. M. Gralnek, R. Jakobs, F. Hagenmüller, H. Neuhaus, J. F. Riemann

A colon cleansing procedure using PEG+ascorbic acid (including boosts) for capsule colonoscopy was tested in 50 patients and yielded a high cleansing level in >80% of patients, a completion rate of 76%, and 91% sensitivity to detect polyps >6mm. In light of the relatively low completion rate, this regimen may be useful for patients in whom sodium phosphate-based preparations are contraindicated.

Fig.1 Colon cleansing grading scale used to objectively describe the preparation of the colon at the time of capsule endoscopy. a Grade 1 (poor) – large amount of fecal residue. b Grade 2 (fair) – enough feces or dark fluid present to preclude a completely reliable examination. c Grade 3 (good) –small amount of feces or dark fluid, but not enough to interfere with examination. d Grade 4 (excellent) –no more than small bits of adherent feces.

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Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study

K. F. Binmoeller, J. N. Shah

Using a porcine model, the authors assessed the feasibility of endoscopic ultrasound (EUS)-guided gastroenterostomy using novel devices and techniques. In all pigs, an anchor wire, an access device, and a fully covered metal stent with bilateral lumen-apposing anchors were used sequentially to create the gastroenterostomy between the water-filled small bowel and the stomach. No complications were reported; patency of the tracts for gastroscopy was observed and fusion of gastric and small-bowel walls after 4.5– 5.5 weeks was histologically confirmed in all cases. Such EUS-guided approaches could, after adequate clinical validation, offer an alternative to surgical interventions for palliation of malignant gastric outlet obstruction.

Fig.4 Endosonographic views of the creation of a gastroenterostomy showing: a the catheter of the access device being advanced over the trocar after transgastric puncture of the small bowel; b the fully deployed stent in position. (ST, stomach; SB, small bowel; PF, proximal flange; DF, distal flange.).

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Endoscopic ultrasound-guided vascular therapy: is it safe and effective?

J.-M. Gonzalez, C. Giacino, M. Pioche, G. Vanbiervliet, S. Brardjanian, P. Ah-Soune, V. Vitton, J.-C. Grimaud, M. Barthet

Fig.1 Images taken during the endoscopic ultrasound (EUS) evaluation and treatment of a patient with Dieulafoy's ulcer (patient number 6) showing the arterial loop penetrating the gastric wall.

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Single-step endoscopic ultrasonography-guided drainage of peripancreatic fluid collections with a single self-expandable metal stent and standard linear echoendoscope

M. Berzosa, S. Maheshwari, K. K. Patel, Y. H. Shaib

Fig.1 Steps in the drainage of peripancreatic fluid collections (PFCs) a Endoscopic ultrasonography-guided needle puncture of a PFC. b A guide wire was sent through the stomach wall into the cyst prior to the needle-knife cut. c Dilation of the tract with an 8-mm biliary balloon after needle-knife cut. d Free flow of pus through the stent into the stomach after placement of the self-expandable metal stent.

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Current Issue April 2012