MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Techniques in Gastrointestinal Endoscopy' source. Mon, 28 Nov 2011 04:57:25 +0100 http://www.medworm.com/index.php?rid=5388549&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001252%2Fabstract%3Frss%3Dyes The key to improving ambulatory endoscopy center (AEC) performance revolves around implementing certain key activities while at the same time consistently measuring and reporting specific mission-critical metrics throughout the organization. Although many of these key activities could be described as “business fundamentals,” the impact of health care reform will be driven home within the AEC environment as reimbursement transforms from the purely fee-for-service model to other alternate reimbursement arrangements. Although other contributions to this issue focus on potential future reimbursement models in more detail, a focus on quality and cost-effectiveness is a common theme in most potential new reimbursement mechanisms. In the historical AEC environment, procedural volume has alway... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388549 Sat, 01 Oct 2011 04:00:00 +0100 5388549 http://www.medworm.com/index.php?rid=5388548&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000556%2Fabstract%3Frss%3Dyes Proper reimbursement and regulatory compliance for GI endoscopy facility services require understanding of the payment system, how Medicare and other payers determine fees, and the many nuances of how to code and bill effectively. A short review with useful references is presented here. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388548 Sat, 01 Oct 2011 04:00:00 +0100 5388548 http://www.medworm.com/index.php?rid=5388547&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001379%2Fabstract%3Frss%3Dyes The use of anesthesia provider services in the ambulatory endoscopy setting represents an important collaboration given current guidance. This chapter reviews a unique, personal experience for developing a relationship between providers in this setting from a business model perspective. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388547 Sat, 01 Oct 2011 04:00:00 +0100 5388547 http://www.medworm.com/index.php?rid=5388546&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001550%2Fabstract%3Frss%3Dyes Ambulatory surgery centers remain strong sites for physician services in the outpatient setting. The relationship between endoscopists and surgery centers can be complex from a financial and legal standpoint. The interpretation of Stark and Anti-Kickback laws is a dynamic target, constantly being sifted by legal minds, and is the topic of review in this chapter. Other important issues are reviewed within the context of current interpretation and analysis. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388546 Sat, 01 Oct 2011 04:00:00 +0100 5388546 http://www.medworm.com/index.php?rid=5388545&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000544%2Fabstract%3Frss%3Dyes Information technology holds promise for improving communication, increasing quality, and reducing costs for our health care system. In the ambulatory endoscopy center (AEC), procedure report generating software has evolved over nearly 30 years to fit more closely within this paradigm. Many software systems now allow communication with electronic health record and practice management systems, ancillary service electronic solutions, and regional health information exchanges. The opportunity to use such systems to participate effortlessly with quality reporting programs now exists as well. Automation of procedure-related information including the procedure report, nursing and anesthesia documentation, and endoscopy inventory data has been shown to reduce AEC expense and increase efficiency. ... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388545 Sat, 01 Oct 2011 04:00:00 +0100 5388545 http://www.medworm.com/index.php?rid=5388544&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001239%2Fabstract%3Frss%3Dyes Seeking accreditation initiates a process of self-evaluation as an organization measures itself against established national standards related to patient safety and quality of care. There is value in the preparation process in terms of awareness of and the internalizing and operationalization of nationally accepted standards. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388544 Sat, 01 Oct 2011 04:00:00 +0100 5388544 http://www.medworm.com/index.php?rid=5388543&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001227%2Fabstract%3Frss%3Dyes This article reviews principles pertaining to defining and selecting improvement goals and the various methodologies often employed in pursuing them. Further reading is encouraged in regard to specific methods for use by improvement teams. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388543 Sat, 01 Oct 2011 04:00:00 +0100 5388543 http://www.medworm.com/index.php?rid=5388542&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001240%2Fabstract%3Frss%3Dyes Infection related issues are an important concern in ambulatory endoscopy centers. Safety is paramount. Maintenance of effective infection control processes is a crucial component of safety in endoscopy, and proper reprocessing of endoscopic equipment must be viewed as an important part of any procedure. Critical issues in reducing the risk of transmission of infection during endoscopic procedures include general infection control principles, safe injection practices and meticulous endoscope reprocessing. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388542 Sat, 01 Oct 2011 04:00:00 +0100 5388542 http://www.medworm.com/index.php?rid=5388541&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000568%2Fabstract%3Frss%3Dyes Optimizing value in health care delivery is the primary driver of the health care reform initiative. The value proposition in health care requires that the quality of care is maximized whereas excess costs of medical errors, adverse events, redundancy, and overutilization are minimized or eliminated. Ambulatory endoscopy centers (AECs), because of their significant role in care delivery, are compelled to address the primary health care reform objectives to remain competitive in the reform era. One of the earliest demands includes the expansion of efficiency and capacity to accommodate the growing insured population and the influx of baby-boomers into Medicare coverage. Adoption of electronic health records and connectivity through health information exchange will provide an infrastructure ... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388541 Sat, 01 Oct 2011 04:00:00 +0100 5388541 http://www.medworm.com/index.php?rid=5388540&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001367%2Fabstract%3Frss%3Dyes “Let me have men about me that are fat; sleek-headed men and such as sleep o' nights.” (William Shakespeare, The Tragedy of Julius Caesar) Caesar was alluding to prosperity, wisdom, and ethical calm when he said these lines. Endoscopists who practice in ambulatory endoscopy centers (AECs) face increasing challenges as health care reform unfolds and can use the experienced voices that can bring us opportunities for prosperity, acumen, and calm. It is a privilege to provide an introduction for my colleagues and partners who have offered their formidable experience and opinion to help educate us as we move further down this road. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388540 Sat, 01 Oct 2011 04:00:00 +0100 5388540 http://www.medworm.com/index.php?rid=5388539&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001598%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388539 Sat, 01 Oct 2011 04:00:00 +0100 5388539 http://www.medworm.com/index.php?rid=5388538&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001586%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388538 Sat, 01 Oct 2011 04:00:00 +0100 5388538 http://www.medworm.com/index.php?rid=5388537&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001574%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388537 Sat, 01 Oct 2011 04:00:00 +0100 5388537 http://www.medworm.com/index.php?rid=5388536&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001562%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5388536 Sat, 01 Oct 2011 04:00:00 +0100 5388536 http://www.medworm.com/index.php?rid=5209972&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001173%2Fabstract%3Frss%3Dyes Simulation is an important component of training in gastrointestinal endoscopy. Each endoscopic procedure has unique risks. Risks are more serious in advanced endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), and natural orifice translumenal endoscopic surgery (NOTES). Using simulation of advanced endoscopic procedures before performing these procedures in humans is beneficial. Because equipment and accessories change rapidly with developing technology, the use of simulators is also important for maintaining skills of practicing endoscopists as well as teaching new procedures in formal fellowships or training programs. Each simulation platform has its own menu of pros and cons. This review includes recent devel... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209972 Fri, 01 Jul 2011 04:00:00 +0100 5209972 http://www.medworm.com/index.php?rid=5209971&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001197%2Fabstract%3Frss%3Dyes The example of Vietnam demonstrates the wide range of endoscopic capabilities in an underdeveloped country with emerging economic strength. Barriers to advancement in endoscopic techniques can be overcome through the donation of equipment and on-site, hands-on training. In a country where the endoscopists are experienced and skillful in basic techniques, significant advances in health care delivery can be achieved with relatively small investments in time and money. This process is naturally enormously gratifying for both the students and their mentors. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209971 Fri, 01 Jul 2011 04:00:00 +0100 5209971 http://www.medworm.com/index.php?rid=5209970&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001203%2Fabstract%3Frss%3Dyes Training in the performance of endoscopic procedures has traditionally been given in the endoscopy suite under the supervision of a guiding physician. This approach typically results in a significant learning curve, showing enhanced cognitive skills and “hand–eye” coordination. Recent developments in medical simulation seem promising with regard to the possibility of training outside the endoscopy suite, thereby minimizing potential patient discomfort and being less stressful for both the trainee and the supervising physician. Various types of simulators are available and have been promoted as an educational tool to accelerate the training curve and to provide objective measures of procedural competency. The purpose of this paper is to review the studies performed using various simul... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209970 Fri, 01 Jul 2011 04:00:00 +0100 5209970 http://www.medworm.com/index.php?rid=5209969&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001185%2Fabstract%3Frss%3Dyes Simulators have been used to enhance traditional endoscopy teaching since the 1970s. Endoscopic simulators have been developed for training in esophagogastroduodenoscopy, colonoscopy, and endoscopic retrograde cholangiopancreatoscopy (ERCP). Evidence in the literature supports the use of endoscopic simulators as valuable tools in learning these endoscopic procedures. Currently, there is increased use of choledochoscopy, which is considered one of the most technically challenging procedures performed by interventional endoscopists. Because of its technical complexity, choledochoscopy serves as an ideal candidate for simulation-based endoscopic skills training in the preclinical setting. The aim of this chapter is to evaluate the available simulators for ERCP and to assess their utility as a... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209969 Fri, 01 Jul 2011 04:00:00 +0100 5209969 http://www.medworm.com/index.php?rid=5209968&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000945%2Fabstract%3Frss%3Dyes Endoscopic ultrasound (EUS) is probably the most challenging endoscopic technique to learn because it not only requires comprehension of luminal endoscopy, but also compels the endoscopist to be able to understand ultrasound and recognize three-dimensional anatomy. As a result, the learning curve for EUS is steep and requires a large volume of wide-ranging cases to successfully accomplish training. Endoscopic simulators have the potential to play a unique role in EUS training based on the ability to simulate visual and tactile experiences that one would encounter during actual EUS procedures. Over the past few decades a variety of EUS training simulators have been developed to facilitate EUS training. This review will discuss current simulators available and their potential impact on EUS t... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209968 Fri, 01 Jul 2011 04:00:00 +0100 5209968 http://www.medworm.com/index.php?rid=5209967&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001215%2Fabstract%3Frss%3Dyes Endoscopic management of acute gastrointestinal (GI) bleeding is an advanced procedure associated with high morbidity and mortality. The traditional apprentice model of training for such events is often inadequate because of their unpredictable frequency, common occurrence off hours, and high stakes for patient outcome. Hemostasis is the cessation of active bleeding and prevention of rebleeding with an endoscopic intervention. Proficiency in endoscopic management of GI hemorrhage includes proper preparation, a systematic categorization of both the source of bleeding and the technique used to control it, the necessary knowledge base, and technical skills to perform the endoscopic intervention. Various simulation platforms, including virtual reality simulators, in vivo models, and explanted ... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209967 Fri, 01 Jul 2011 04:00:00 +0100 5209967 http://www.medworm.com/index.php?rid=5209966&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831100101X%2Fabstract%3Frss%3Dyes Simulation offers a unique and possibly essential tool to train endoscopists in safe and successful gastrointestinal endoscopy using procedural sedation. In turn, it is becoming more common to integrate procedural trainers into full-scale environments to allow simulation of both technical and behavioral skills required to perform sedated procedures, as well as communication skills that are fundamental in effective and high-quality endoscopy teams. Generally speaking, simulation can be used to “animate the textbook” by creating simulated encounters around a myriad of sedation regimens to teach and reinforce safe practice through a deepened understanding of pharmacology and patient–drug interactions. In this chapter, we present our experience designing full-scale simulated endoscopy sc... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209966 Fri, 01 Jul 2011 04:00:00 +0100 5209966 http://www.medworm.com/index.php?rid=5209965&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001021%2Fabstract%3Frss%3Dyes Current American Society for Gastrointestinal Endoscopy and American College of Gastroenterology guidelines recommend that credentialing should occur for upper endoscopy and colonoscopy after at least 130-140 endoscopic procedures have been performed. We reviewed the currently available literature published on endoscopic simulators including the AccuTouch Immersion Simulator, the Simbionix GI Mentor II, and the Olympus colonoscopy simulator to determine their utility for training in diagnostic endoscopy, flexible sigmoidoscopy, and colonoscopy. All of the endoscopic simulators demonstrated face, construct, and expert validity when comparing novices with experts in the performance of diagnostic endoscopic procedures. For diagnostic upper endoscopy, clinical trials comparing training on an e... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209965 Fri, 01 Jul 2011 04:00:00 +0100 5209965 http://www.medworm.com/index.php?rid=5209964&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831100129X%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209964 Fri, 01 Jul 2011 04:00:00 +0100 5209964 http://www.medworm.com/index.php?rid=5209963&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001288%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209963 Fri, 01 Jul 2011 04:00:00 +0100 5209963 http://www.medworm.com/index.php?rid=5209962&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001276%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209962 Fri, 01 Jul 2011 04:00:00 +0100 5209962 http://www.medworm.com/index.php?rid=5209961&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311001264%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=5209961 Fri, 01 Jul 2011 04:00:00 +0100 5209961 http://www.medworm.com/index.php?rid=4947008&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831100026X%2Fabstract%3Frss%3Dyes This article reviews the theoretic framework and evidence base supporting the use of simulation in this role. It raises questions regarding the tools used for both clinical and simulated assessment and identifies 2 gaps that must be filled before simulation can fulfill the potential to enable high-quality, reliable, and, most importantly, repeatable assessments of competency. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947008 Thu, 31 Mar 2011 23:00:00 +0100 4947008 http://www.medworm.com/index.php?rid=4947007&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000088%2Fabstract%3Frss%3Dyes With the development of any new technology or educational curriculum, validation of its effectiveness is a critical but often overlooked step. When validation is performed, it is often done in a very superficial manner and all too often the results are wrongly extrapolated to draw conclusions on findings independent of the aspects validated. In this review we describe the process required to establish rigorous and more accurate validation evidence of simulation tools and teaching curriculum. These steps will be demonstrated through the review of our experiences with computerized colonoscopy simulators over the past decade. As educators and researchers, placing a focus on developing strong validity evidence for the use of new educational tools is something we owe not only to our trainees an... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947007 Thu, 31 Mar 2011 23:00:00 +0100 4947007 http://www.medworm.com/index.php?rid=4947006&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000350%2Fabstract%3Frss%3Dyes Gastrointestinal endoscopy is a complex manual task with an extended learning curve. Numerous technologies are emerging that may accelerate the acquisition of endoscopic skills for trainees and experienced practitioners in gastroenterology. A wide variety of endoscopic simulators are available, ranging from ex vivo porcine models to computer simulators with haptic feedback. In parallel with endoscopic simulation, innovations are also occurring in “adjunctive” technologies for live endoscopy (ie, technologies that aim to provide more detailed visual or even 3-dimensional information streams to the endoscopist during a procedure). Such adjunctive technologies include live torque and force monitoring during colonoscopy and 3-dimensional views of scope positioning with respect to patient a... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947006 Thu, 31 Mar 2011 23:00:00 +0100 4947006 http://www.medworm.com/index.php?rid=4947005&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000258%2Fabstract%3Frss%3Dyes Natural orifice transluminal endoscopic surgery (NOTES) is the most recent advancement in minimally invasive surgery of the abdomen. Similar to any newly introduced surgical technique, the extent of clinician training will play a critical role in reducing errors and increasing the safety of the procedure. Therefore, it is of utmost importance to develop an optimal training approach before widespread use of the procedure. This approach must demonstrate effectiveness in teaching and evaluating proficiency and be simultaneously cost-effective. Furthermore, it must provide didactic and hands-on training to ensure proper understanding of the complexities of the NOTES procedure. Hands-on training could begin with inanimate simulators and then move on to animate simulation, followed by case obser... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947005 Thu, 31 Mar 2011 23:00:00 +0100 4947005 http://www.medworm.com/index.php?rid=4947004&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831100057X%2Fabstract%3Frss%3Dyes Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most challenging endoscopic procedures performed by gastroenterologists and carries substantial risks. Therefore, gastroenterologists should be properly trained to be competent with ERCP and minimize risks to the patient. ERCP training can be divided into two broad categories: cognitive and technical/hands-on aspects. Although traditional clinical ERCP training is in the format of the teacher–apprentice system with supervised hands-on practice on patients, simulator training can supplement the trainee experience. Examples of different types of ERCP simulators include live anesthetized animals, ex vivo porcine, computer, and mechanical models. Most of these models have been the subject of published studies testing the fac... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947004 Thu, 31 Mar 2011 23:00:00 +0100 4947004 http://www.medworm.com/index.php?rid=4947003&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000222%2Fabstract%3Frss%3Dyes This article describes the status of endoscopy training in Europe and the current use of simulators in various European countries. Several working groups have developed and established various simulators and training platforms for nearly all diagnostic and interventional techniques. Therefore, the availability of different training simulators is not unexpected in most European countries. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947003 Thu, 31 Mar 2011 23:00:00 +0100 4947003 http://www.medworm.com/index.php?rid=4947002&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831100009X%2Fabstract%3Frss%3Dyes This article highlights the importance of flexible endoscopy to the surgeon and the importance of teaching and reevaluating the educational system for flexible endoscopy for surgeons. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947002 Thu, 31 Mar 2011 23:00:00 +0100 4947002 http://www.medworm.com/index.php?rid=4947001&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000246%2Fabstract%3Frss%3Dyes New endoscopic equipment and devices are constantly being developed and improved. New advanced endoscopic procedures are technically demanding, time consuming, and potentially associated with higher complication rates. There is a growing need for safe methods to perform endoscopic research and training, and their successful performance requires a specific teaching method under standardized learning programs. The live animal models, in addition to other types of endoscopic simulators, such as mechanical devices, computer-generated simulators, and ex vivo tissue animal models, can play a role in teaching and practicing the new advanced endoscopic techniques, similar to their role in laparoscopic surgery and minimally invasive surgery. We discuss the advantages and disadvantages of the live a... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947001 Thu, 31 Mar 2011 23:00:00 +0100 4947001 http://www.medworm.com/index.php?rid=4947000&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000362%2Fabstract%3Frss%3Dyes As to diseases make a habit of two things—to help, or at least, to do no harm.—Hippocrates, Epidemics The Felder–Silverman model describes different types of learning styles based on perceptual modalities, information processing, and personality patterns. Visual learners remember best what they see: pictures, diagrams, flow charts, timelines, films, and demonstrations. Verbal learners comprehend information better through written and spoken explanations. Active learners tend to retain and best understand information by doing something active, by discussing or applying the topic, or by explaining it to others. Reflective learners prefer to acquire information silently by themselves. Sensing learners tend to like learning factual data, whereas intuitive learners often prefer discoveri... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4947000 Thu, 31 Mar 2011 23:00:00 +0100 4947000 http://www.medworm.com/index.php?rid=4946999&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000799%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4946999 Thu, 31 Mar 2011 23:00:00 +0100 4946999 http://www.medworm.com/index.php?rid=4946998&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000787%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4946998 Thu, 31 Mar 2011 23:00:00 +0100 4946998 http://www.medworm.com/index.php?rid=4946997&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000775%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4946997 Thu, 31 Mar 2011 23:00:00 +0100 4946997 http://www.medworm.com/index.php?rid=4946996&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000763%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4946996 Thu, 31 Mar 2011 23:00:00 +0100 4946996 http://www.medworm.com/index.php?rid=4938636&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000040%2Fabstract%3Frss%3Dyes Because esophageal ulceration is extensive after endoscopic submucosal dissection, we have developed a new treatment that combines endoscopic dissection with the endoscopic transplantation of oral mucosal epithelial cell sheets to prevent esophageal stenosis. Cell sheets created from the patient's own oral mucosa were attached directly to the bed of the esophageal ulcer using endoscopic forceps immediately after endoscopic resection. The first application of regenerative medicine to endoscopic treatment was performed in 2008 and more patients are being accumulated. We are working on several advanced research methods using regenerative medicine for endoscopic treatment. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938636 Sat, 01 Jan 2011 00:00:00 +0100 4938636 http://www.medworm.com/index.php?rid=4938635&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000143%2Fabstract%3Frss%3Dyes Gastrointestinal cancer is one of the leading causes of death worldwide. Detection and diagnosis at the pre- or early cancer stage is a critical step for its prevention and cure. Endoscopic resection of pre- or early cancers using techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established curative therapies. Because standard EMR techniques are limited to lesions less than 2 cm in diameter, the ESD technique has recently been developed to allow resection of larger lesions en bloc. After submucosal injection and circumferential incision around the lesion, direct dissection of the submucosa underneath the lesion is performed using 1 of a variety of modified needle-knife instruments: insulation-tipped diathermic knife, hook knife, flex knif... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938635 Sat, 01 Jan 2011 00:00:00 +0100 4938635 http://www.medworm.com/index.php?rid=4938634&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000210%2Fabstract%3Frss%3Dyes The application of standardized protocol by pathologists for handling, grossing, and assessing endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) specimens is critical for accurate diagnosis. To best analyze the specimen, several factors, such as maintenance of proper orientation, meticulous macroscopic examination, accurate mapping of the lesion, and appropriate morphologic diagnosis, must be considered. In Japan, general guidelines in the reporting of endoscopic, pathologic, and surgical findings of patients with gastrointestinal cancers have been used for more than 3 decades. More recently, similar universal guidelines have been developed, including the Paris and Vienna classifications, for clinical and pathologic findings, respectively. The WHO Classification... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938634 Sat, 01 Jan 2011 00:00:00 +0100 4938634 http://www.medworm.com/index.php?rid=4938633&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000325%2Fabstract%3Frss%3Dyes Mastering the techniques of endoscopic hemostasis and perforation closure are critical for any endoscopist venturing into the field of endoscopic mucosal resection and dissection. These techniques could be accomplished to some extent by watching educational videos on the subject and learning from experts by participating in the hands-on courses organized by the American Society of Gastrointestinal Endoscopy. In addition, spending time in centers of excellence and learning from the experts, setting up a room fully furnished with all the necessary endoscopic accessories, and training endoscopic assistants in these procedures are critical for a successful outcome. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938633 Sat, 01 Jan 2011 00:00:00 +0100 4938633 http://www.medworm.com/index.php?rid=4938632&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000179%2Fabstract%3Frss%3Dyes Endoscopic submucosal dissection (ESD) enables less invasive en bloc resection not only in the stomach but also in thinner-walled luminal organs such as the esophagus and colorectum. Although ESD using short needle knives provides safe and effective resection, there are certain challenges to overcome. The long procedure time, the high level of technical difficulty, and the high incidence of complications such as bleeding and perforation are some of the barriers to widespread practice of the technique. Because of the low hemostatic properties of needle knives, such as the standard Flush knife with water jet–emitting function, we have recently developed the ball-tip Flush knife (Flush knife BT). As predicted, the density of the current at the tip of the ball-tip Flush knife decreased compa... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938632 Sat, 01 Jan 2011 00:00:00 +0100 4938632 http://www.medworm.com/index.php?rid=4938631&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000192%2Fabstract%3Frss%3Dyes Endoscopic submucosal dissection has revolutionized endoscopic treatment for early gastrointestinal neoplasm. The technique has overcome the size and resection limitations of endoscopic mucosal resection with injection and standard snaring techniques. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938631 Sat, 01 Jan 2011 00:00:00 +0100 4938631 http://www.medworm.com/index.php?rid=4938630&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000209%2Fabstract%3Frss%3Dyes Endoscopic submucosal dissection (ESD) is a novel endoscopic resection technique that enables reliable en bloc resection of large and difficult gastrointestinal lesions. We initially performed ESD using the tip of a thin-type snare to serve as a blunt-end short needle knife. However, the device had limitations; therefore, we developed a more reliable and durable device, the Flex knife. It cut well in any direction and was easy to control because of its soft and flexible nature, making it extremely useful for ESD of colorectal and esophageal lesions that required delicate maneuvering. Although the Flex knife achieved excellent treatment results, its use was still technically limited by the loop-shape tip, resulting in difficulty with knife length adjustments, frequent intraprocedure accumul... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938630 Sat, 01 Jan 2011 00:00:00 +0100 4938630 http://www.medworm.com/index.php?rid=4938629&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000349%2Fabstract%3Frss%3Dyes The hook knife is a robust device for marking and cutting mucosa, submucosal fibers, and vessels, as well as for hemostasis of minor bleeding. The tip of the knife is bent at a right angle. The length of the hook part is 1.3 mm and that of the arm is 4.5 mm. The knife is hosted within an outer sheath. The tip of the sheath has a hood-like shape that allows the hook of the knife to be retracted within it. The direction of the hook can be adjusted by rotating a handle located on the proximal side of the knife. The hook direction is easily adjusted when the handle is simultaneously rotated and moved slightly back and forth. The hook direction is fixed when the handle is maximally extended. Importantly, the direction of the hook knife should be controlled and kept parallel with the muscularis ... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938629 Sat, 01 Jan 2011 00:00:00 +0100 4938629 http://www.medworm.com/index.php?rid=4938628&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000167%2Fabstract%3Frss%3Dyes Endoscopic submucosal dissection (ESD) has become standard treatment for early gastric and esophageal cancer in Japan. Nearly 10 years have passed since the insulated-tip knife was developed, and the improved type insulated-tip (IT) knife-2 is a more powerful device for ESD. The development and progress of the ESD technique were realized with much cooperation from others who developed the technique of endoscopic mucosal resection, from surgeons who were always available when complications occurred, and from colleagues who worked together in friendly competition. With many thanks for their contributions, the current status of the ESD technique with the IT knife in the stomach, esophagus, and colorectum, as well as its complications, will be discussed. (Source: Techniques in Gastrointestinal... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938628 Sat, 01 Jan 2011 00:00:00 +0100 4938628 http://www.medworm.com/index.php?rid=4938627&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831100012X%2Fabstract%3Frss%3Dyes Endoscopic mucosal resection (EMR) is used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advanced dysplasia and early neoplasia in Barrett's esophagus. This review will describe the basis, indications, techniques, and complications of EMR (the lift-and-cut method). (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938627 Sat, 01 Jan 2011 00:00:00 +0100 4938627 http://www.medworm.com/index.php?rid=4938626&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000477%2Fabstract%3Frss%3Dyes Endoscopic mucosal resection (EMR) is a technique used to locally excise for cure of mucosal lesions and early gastrointestinal cancers that carry minimal risk of nodal metastasis. This review will describe the indications, techniques, and complications of the EMR using a cap (EMR-C) method. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938626 Sat, 01 Jan 2011 00:00:00 +0100 4938626 http://www.medworm.com/index.php?rid=4938625&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000337%2Fabstract%3Frss%3Dyes Well- to moderately differentiated early cancer limited to the mucosal layer and high-grade intraepithelial neoplasia, which have no or minimal risk of distant metastases, can be treated with curative intent using the technique of endoscopic resection. This paper will describe the technique of endoscopic mucosal resection using the multiband ligation technique. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938625 Sat, 01 Jan 2011 00:00:00 +0100 4938625 http://www.medworm.com/index.php?rid=4938624&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000039%2Fabstract%3Frss%3Dyes Endoscopic mucosal resection (EMR) is an important therapy for large sessile lesions and advanced mucosal neoplasia of the colon. Careful pre-resection assessment against established classification systems including Paris and lesion granularity is mandatory to formulate a treatment plan, predict technical success and stratify for the risk of invasive disease. Lesions at high risk for invasive disease are best removed en bloc and this finding may dictate a change in the therapeutic strategy. Meticulous technique is crucial to maximise procedural success. This chapter will provide a comprehensive step by step approach to colonic EMR including equipment selection, lesion assessment, endoscopic technique, post procedural care and early detection and management of complications. (Source: Techni... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938624 Sat, 01 Jan 2011 00:00:00 +0100 4938624 http://www.medworm.com/index.php?rid=4938623&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000106%2Fabstract%3Frss%3Dyes This article describes the submucosal injection technique applied in endoscopic mucosal resection and endoscopy submucosal dissection, with an emphasis on a particular technique used in our practice, the dynamic submucosal injection technique. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938623 Sat, 01 Jan 2011 00:00:00 +0100 4938623 http://www.medworm.com/index.php?rid=4938622&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000052%2Fabstract%3Frss%3Dyes Colorectal cancer is the third most prevalent cause of cancer-related mortality in Japan, and the incidence of submucosal colorectal cancer is increasing. To reduce colorectal cancer mortality, however, early detection of colorectal cancer is required and adequate diagnosis of depth is needed. Current endoscopes provide high-resolution imaging that result in clear, vivid features of the detected lesions. In particular, when combined with image enhancement, high-magnification endoscopy can provide a detailed analysis of the morphologic architecture of the pit pattern and the capillary pattern in a simple and quick manner. Characteristic colonoscopic findings obtained by a combination of conventional colonoscopy, magnifying chromoendoscopy, and narrow-band imaging are useful for determining ... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938622 Sat, 01 Jan 2011 00:00:00 +0100 4938622 http://www.medworm.com/index.php?rid=4938621&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000155%2Fabstract%3Frss%3Dyes Accurate endoscopic determination of invasion depth for gastric cancer is essential in making the proper decisions for planning treatment strategy. The use of endoscopic resection such as endoscopic submucosal dissection has become more widespread in treating early gastric cancer, particularly in Asia. As a result, differential endoscopic diagnosis between mucosal and submucosal depth of invasion has become increasingly important in determining the indications for endoscopic resection. Endoscopy is the primary modality for diagnosing gastric cancer. Correlations between macroscopic type and invasion depth for early gastric cancer have been reported in the Paris endoscopic classification of superficial neoplastic lesions; thus, the proper use of macroscopic classification is helpful in dete... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938621 Sat, 01 Jan 2011 00:00:00 +0100 4938621 http://www.medworm.com/index.php?rid=4938620&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000313%2Fabstract%3Frss%3Dyes In esophageal squamous cell carcinoma, the depth of invasion into the wall is closely associated with metastasis to lymph nodes. Esophageal cancer invading the muscularis mucosae could be curably treated by endoscopic submucosal dissection but cancer with submucosal invasion necessitates surgical resection and/or chemoradiotherapy. Therefore, pretreatment diagnosis of invasion depth is crucially important for selecting appropriate treatment strategies for each individual patient. To estimate the depth of cancer invasion for early squamous cell carcinoma of the esophagus, standard endoscopy with image enhancement and endoscopic ultrasound are currently considered the best methods. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938620 Sat, 01 Jan 2011 00:00:00 +0100 4938620 http://www.medworm.com/index.php?rid=4938619&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000118%2Fabstract%3Frss%3Dyes White light endoscopy is a basic tool available to gastroenterologists since the early 1960s, when flexible endoscopy was first introduced. Since then, gastroenterologists have been able to diagnose and treat gastrointestinal diseases at earlier stages. However, recent studies have also highlighted the limitations and imperfect nature of white light endoscopy. Image-enhanced endoscopy (IEE) has been available for the past 10 years and has been validated by research and clinical trials. A specific combination of dye-based (Lugol's solution, indigo carmine) and equipment-based IEE (narrow band imaging, Fujinon Intelligence Color Enhancement, Pentax i-Scan) is indicated for use in the oropharynx, hypopharynx, esophagus, stomach, and colon. The main use is for detecting, diagnosing, and treati... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938619 Sat, 01 Jan 2011 00:00:00 +0100 4938619 http://www.medworm.com/index.php?rid=4938618&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000489%2Fabstract%3Frss%3Dyes Two diseases—Barrett's esophagus and neoplasia of the colon and rectum—are the primary targets for endoscopic resection in Western countries. Having these diseases in mind, we have been fortunate to have the many expert authors of this monograph to summarize the endoscopic resection techniques that they use in daily practice, including endoscopic mucosal resection and endoscopic submucosal dissection. Such local endoscopic removal techniques are important because they provide a resection specimen of pre- and early gastrointestinal cancer, allowing for precise histopathologic staging to further direct diagnosis, prognosis, and management decisions. We sincerely thank each of them for their great efforts and the Editorial team for providing us with the opportunity to contribute to this J... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938618 Sat, 01 Jan 2011 00:00:00 +0100 4938618 http://www.medworm.com/index.php?rid=4938617&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000660%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938617 Sat, 01 Jan 2011 00:00:00 +0100 4938617 http://www.medworm.com/index.php?rid=4938616&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000659%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938616 Sat, 01 Jan 2011 00:00:00 +0100 4938616 http://www.medworm.com/index.php?rid=4938615&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000647%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938615 Sat, 01 Jan 2011 00:00:00 +0100 4938615 http://www.medworm.com/index.php?rid=4938614&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000635%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4938614 Sat, 01 Jan 2011 00:00:00 +0100 4938614 http://www.medworm.com/index.php?rid=4806821&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000076%2Fabstract%3Frss%3Dyes Endoscopic management of nonmalignant leaks, perforations, and ruptures becomes increasingly important with the growing availability of endoscopic therapy. In general, treatment strategies depend on the time of intervention (immediate complication management vs therapy of chronic fistulas and leaks). The approach used to close an acute perforation is adopted from surgical closure techniques, although a serosa-to-serosa adaptation is difficult to achieve, even with new devices. Nonacute leaks—if not treated by stents—are more complex and treatment is based on secondary wound closure after implantation of certain materials and devices. Nevertheless, apart from these general considerations it is important to know that therapy is not standardized and is therefore often based on a patient's... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806821 Thu, 30 Sep 2010 23:00:00 +0100 4806821 http://www.medworm.com/index.php?rid=4806820&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000180%2Fabstract%3Frss%3Dyes We present an overview of the management of these conditions using metal and nonmetal self-expandable stents. Technical suggestions and clinical issues are discussed in detail and analyzed with regard to outcome and follow-up. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806820 Thu, 30 Sep 2010 23:00:00 +0100 4806820 http://www.medworm.com/index.php?rid=4806819&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000301%2Fabstract%3Frss%3Dyes Approximately 10% of benign esophageal strictures appear to be refractory to standard dilation therapy. Temporary stent placement is an alternative therapeutic option for these cases. However, only one-third of patients with refractory benign esophageal strictures remain dysphagia free after self-expanding stent placement. Stent migration and hyperplastic tissue reaction limit the efficacy of this type of treatment. Novel stents should be designed to overcome these problems. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806819 Thu, 30 Sep 2010 23:00:00 +0100 4806819 http://www.medworm.com/index.php?rid=4806818&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000234%2Fabstract%3Frss%3Dyes This article will review the role of standard and adjunctive therapies for benign esophageal strictures. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806818 Thu, 30 Sep 2010 23:00:00 +0100 4806818 http://www.medworm.com/index.php?rid=4806817&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000064%2Fabstract%3Frss%3Dyes This article reviews the history and current state of antireflux stents. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806817 Thu, 30 Sep 2010 23:00:00 +0100 4806817 http://www.medworm.com/index.php?rid=4806816&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000131%2Fabstract%3Frss%3Dyes Esophageal stents are approved for palliation of malignant esophageal disease. Stents are more commonly used for relief of dysphagia caused by esophageal cancer (intrinsic obstruction) located in the mid or distal esophagus. Less common indications for esophageal stent placement for malignant disease include extrinsic compression from intrathoracic masses and lymphadenopathy, esophagorespiratory fistulas, and high proximal esophageal obstruction. More recently, self-expandable stents have been placed for benign esophageal conditions, with indications similar to those for malignant disease; currently only a plastic stent has Food and Drug Administration approval for these indications. This review outlines the techniques and outcomes of esophageal stent placement for uncommon indications and... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806816 Thu, 30 Sep 2010 23:00:00 +0100 4806816 http://www.medworm.com/index.php?rid=4806815&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000295%2Fabstract%3Frss%3Dyes Of all nonstent modalities available for palliating esophageal cancer, brachytherapy with or without external beam radiation therapy is the best modality, providing a survival benefit with a better quality of life in the long-term compared with stent placement. Both stent placement and brachytherapy provide comparable palliation to endoscopic chemical ablative therapy but are preferable because of the reduced requirement for reintervention. Other available modalities, such as laser therapy, photodynamic therapy, or chemical ablation, are not recommended for palliation of dysphagia because of a high incidence of complications and recurrent dysphagia. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806815 Thu, 30 Sep 2010 23:00:00 +0100 4806815 http://www.medworm.com/index.php?rid=4806814&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000271%2Fabstract%3Frss%3Dyes This article reviews currently available SEMS, considerations for choosing SEMS type, indications for SEMS, techniques for SEMS placement, efficacy data, and complications. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806814 Thu, 30 Sep 2010 23:00:00 +0100 4806814 http://www.medworm.com/index.php?rid=4806813&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000027%2Fabstract%3Frss%3Dyes Esophageal stents have evolved in stages over the years. First introduced over 120 years ago, they were used uncommonly until the Celestin tube in the 1970s, which initiated the era of rigid prosthesis use for the next 20 years. These tubes were fraught with high complication rates, leading to their evolutionary demise and ushering in the current era of self-expanding stents. The latter began as metal (stainless steel followed by nitinol) and have now come to include plastic and biodegradable materials. There are many choices of different types of stents and sizes, with fierce competition among manufacturers. However, several limiting factors remain with current stent technology and the body's response to them. The ideal stent remains elusive. Future needs include focusing on reducing comp... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806813 Thu, 30 Sep 2010 23:00:00 +0100 4806813 http://www.medworm.com/index.php?rid=4806812&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000283%2Fabstract%3Frss%3Dyes Although stents had already been known for more than a century, the first serious use of stents in the esophagus was in the 1970s with the introduction of Celestin tubes. However, these rigid tubes were associated with high complication rates. This resulted in the development of self-expanding stents, which were initially made of stainless steel, followed by Nitinol, and have now come to include plastic and biodegradable materials. There are many choices of materials, types of stents, and sizes. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806812 Thu, 30 Sep 2010 23:00:00 +0100 4806812 http://www.medworm.com/index.php?rid=4806811&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000404%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806811 Thu, 30 Sep 2010 23:00:00 +0100 4806811 http://www.medworm.com/index.php?rid=4806810&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000398%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806810 Thu, 30 Sep 2010 23:00:00 +0100 4806810 http://www.medworm.com/index.php?rid=4806809&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000386%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806809 Thu, 30 Sep 2010 23:00:00 +0100 4806809 http://www.medworm.com/index.php?rid=4806808&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288311000374%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4806808 Thu, 30 Sep 2010 23:00:00 +0100 4806808 http://www.medworm.com/index.php?rid=4363831&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831000046X%2Fabstract%3Frss%3Dyes Primary endoscopic obesity treatments include a variety of restrictive and malabsorptive procedures that are emerging as alternatives to bariatric surgery. Although bariatric surgery is extremely effective and generally considered safe, there is a small, albeit significant, morbidity and mortality. This makes less invasive treatments attractive. In addition to being less invasive and perhaps safer, endoscopic treatments may be more cost-effective and reversible. Additionally, endoscopic treatments may prove to be a viable alternative in poor surgical candidates, or as a method to induce weight loss in super obese patients before definitive surgical bariatric procedures, and may be an option for the nonmorbidly obese who have failed diet and exercise. Experience with these emerging endoscop... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363831 Thu, 01 Jul 2010 00:00:00 +0100 4363831 http://www.medworm.com/index.php?rid=4363830&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000525%2Fabstract%3Frss%3Dyes In the care of post Roux-en-Y gastric bypass (RYGB) surgery patients, the late complications of suboptimal weight loss and weight regain are common. Although surgical revision has been the standard of care for these patients, there are now endoscopic technologies and endoluminal procedures available to help gastrointestinal endoscopists obtain similar treatment outcomes with much less associated morbidity. The aim of this article is to review the published literature and endoscopic techniques currently utilized for the endoluminal revision of post-bypass patients. Specifically, we review the use and outcomes of sclerotherapy, endoluminal suturing with the EndoCinch, EndoSurgical Operating System, and StomaphyX systems in the treatment of dilated gastrojejunal stomas and gastric pouches—c... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363830 Thu, 01 Jul 2010 00:00:00 +0100 4363830 http://www.medworm.com/index.php?rid=4363829&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000495%2Fabstract%3Frss%3Dyes Common bile duct obstruction by gallstones is a frequent occurrence in patients following rapid weight loss after successful Roux-en-Y gastric bypass. The challenge of accessing the papilla and performing successful therapeutic ERCP is undergoing rapid development. This chapter will review recent developments and suggest a treatment algorithm. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363829 Thu, 01 Jul 2010 00:00:00 +0100 4363829 http://www.medworm.com/index.php?rid=4363828&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000501%2Fabstract%3Frss%3Dyes The ingestion of foreign bodies or food bolus impaction occur at different natural or pathologic levels of narrowing of the esophagus. In bariatric patients, postoperative “strictures” could arise at the level of the gastric body (in sleeve gastrectomy) or the gastrojejunal anastomosis (in Roux-en-Y gastric bypass) or at the level of surgical foreign body insertion: the ring (for vertical banded gastroplasty) and band (for laparoscopic adjustable banding). In these patients, food intolerance is a common complication requiring combination of medical, endoscopic, and surgical management that we review here. We emphasize the role of endoscopic dilation of strictures and the newly described endoscopic techniques for the removal of dysfunctioning ring or band after restrictive surgery, by t... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363828 Thu, 01 Jul 2010 00:00:00 +0100 4363828 http://www.medworm.com/index.php?rid=4363827&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000537%2Fabstract%3Frss%3Dyes Gastric leaks are an ominous complication following Roux-en-Y gastric bypass associated with a high mortality. Surgical revision is often complicated and not without risk. Several series have brought to light endoscopic interventions that may play a role in the management of these patients. This paper provides an overview of the surgical approach to this difficult problem and outlines several endoscopic approaches to gastric leak and fistulae management, including stents, clips, fibrin glue, and endoscopic suturing. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363827 Thu, 01 Jul 2010 00:00:00 +0100 4363827 http://www.medworm.com/index.php?rid=4363826&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000483%2Fabstract%3Frss%3Dyes Gastric bypass remains the leading bariatric procedure performed in the United States, and the number of surgeries performed is increasing dramatically in the face of an intractable obesity epidemic. Although highly effective in the treatment of obesity, the procedure is associated with several significant complications. Anastomotic stricture formation is one of the major postoperative complications encountered by gastroenterologists. Strictures are common, occurring in a significant minority of patients. They generally present with intolerance to oral intake within the first 6 months of surgery. The etiology of stricture formation is not fully know but may be partially related to surgical technique in creating the anastomosis. Endoscopy is an excellent diagnostic test and allows for immed... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363826 Thu, 01 Jul 2010 00:00:00 +0100 4363826 http://www.medworm.com/index.php?rid=4363825&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000471%2Fabstract%3Frss%3Dyes Upper gastrointestinal hemorrhage (UGH) is a potential postoperative complication after bariatric surgery. The etiology of postoperative UGH after open or laparoscopic gastric bypass is most likely related to problems at the staple line. There are four potential sites of staple-line hemorrhage: the gastrojejunostomy, the gastric pouch, the jejunojejunostomy, and the excluded stomach. The site of bleeding can sometimes be predicted based on the clinical presentation. Early bleeding usually occurs at the gastrojejunostomy. Late UGH is commonly caused by a marginal ulcer. Upper endoscopy is safe and effective in controlling hemorrhage with standard endoscopic techniques, even in the early postoperative period and may obviate the need for surgery. Hemostatic methods include epinephrine, electr... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363825 Thu, 01 Jul 2010 00:00:00 +0100 4363825 http://www.medworm.com/index.php?rid=4363824&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000549%2Fabstract%3Frss%3Dyes This article reviews basic obesity epidemiology and describes postsurgical anatomy of the upper gastrointestinal tract, separating the procedures into those with normal small bowel anatomy (restrictive procedures) and procedures resulting in small bowel modifications (procedures with a “malabsorptive” component). (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363824 Thu, 01 Jul 2010 00:00:00 +0100 4363824 http://www.medworm.com/index.php?rid=4363823&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000513%2Fabstract%3Frss%3Dyes Obesity has reached near pandemic status. In the USA approximately 1 in 5 individuals over 18 years of age is considered obese, having a body mass index of 30 kg/m2 or greater. Additionally, the estimated cost of obesity and its related comorbidities is thought to exceed 100 billion dollars annually. To date, dietary programs, behavioral modification, and medical therapies have had limited success. Bariatric surgery, however, provides a means of effective weight loss for many patients with morbid obesity, and it is estimated that over 200,000 obesity procedures are performed in the USA each year. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363823 Thu, 01 Jul 2010 00:00:00 +0100 4363823 http://www.medworm.com/index.php?rid=4363822&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000586%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363822 Thu, 01 Jul 2010 00:00:00 +0100 4363822 http://www.medworm.com/index.php?rid=4363821&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000574%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363821 Thu, 01 Jul 2010 00:00:00 +0100 4363821 http://www.medworm.com/index.php?rid=4363820&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000562%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363820 Thu, 01 Jul 2010 00:00:00 +0100 4363820 http://www.medworm.com/index.php?rid=4363819&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000550%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=4363819 Thu, 01 Jul 2010 00:00:00 +0100 4363819 http://www.medworm.com/index.php?rid=3558023&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000173%2Fabstract%3Frss%3Dyes This article reviews the current progress in using biomarkers in each of the clinical settings described earlier with a focus on the molecular biomarkers, which have advanced the farthest toward use in routine clinical practice. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558023 Wed, 31 Mar 2010 23:00:00 +0100 3558023 http://www.medworm.com/index.php?rid=3558022&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831000032X%2Fabstract%3Frss%3Dyes This article reviews the rationale, indications, methods and outcomes of endoscopic mucosal resection in Barrett's esophagus. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558022 Wed, 31 Mar 2010 23:00:00 +0100 3558022 http://www.medworm.com/index.php?rid=3558021&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000161%2Fabstract%3Frss%3Dyes Barrett's esophagus, a metaplastic change in the esophagus wherein normal squamous epithelium is replaced by specialized columnar epithelium, is a complication of chronic gastroesophageal reflux disease. There is an association between Barrett's esophagus and esophageal adenocarcinoma. Since 1977, esophageal cancer has increased by more than 500% in the United States. The optimal treatment for dysplastic Barrett's esophagus is unclear. One method for treating dysplastic Barrett's esophagus is radiofrequency ablation (RFA). RFA has been shown to effectively induce reversion to neosquamous tissue, and has been demonstrated in a randomized trial to significantly decrease the risk of progression of dysplasia to cancer. Minimal complications have been reported, and the technique can be performe... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558021 Wed, 31 Mar 2010 23:00:00 +0100 3558021 http://www.medworm.com/index.php?rid=3558020&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000288%2Fabstract%3Frss%3Dyes This article discusses the current technique for performing endomicroscopy as it is applied for evaluation of patients with BE and compares the two available systems. Learning endomicroscopy requires technical mastery to obtain stable images and cognitive mastery of endomicroscopy image interpretation. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558020 Wed, 31 Mar 2010 23:00:00 +0100 3558020 http://www.medworm.com/index.php?rid=3558019&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000112%2Fabstract%3Frss%3Dyes The goal of surveillance in Barrett's esophagus is the detection and treatment of early neoplasia. It has been shown that patients with early lesions (intraepithelial neoplasia or intramucosal cancer) can be cured with a high success rate. This is in contrast to advanced esophageal adenocarcinoma, which has a poor prognosis. Currently, many authorities regard endoscopic treatment for early neoplasia as equivalent, if not superior, to radical surgery because the cure rates are comparable with less mortality and morbidity. With the rising popularity of, and the expanding experience with, endoscopic treatment, principally endoscopic resection, precise localization of the neoplastic lesions within the Barrett's segment has become important for precise staging and successful resection. This loc... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558019 Wed, 31 Mar 2010 23:00:00 +0100 3558019 http://www.medworm.com/index.php?rid=3558018&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000197%2Fabstract%3Frss%3Dyes Barrett's esophagus (BE) is the replacement of the normal squamous lining of the distal esophagus by columnar mucosa. It is the recognized precursor of esophageal adenocarcinoma, with tumors arising through an inflammation–metaplasia–dysplasia–carcinoma sequence. Effective communication between the gastroenterologist and pathologist is crucial to the diagnosis, risk assessment, and management of BE. This review will focus on the histopathologic aspects of BE especially relevant to the practicing gastroenterologist, including discussion of normal anatomy and histology of the distal esophagus and gastroesophageal junction, varying definitions of BE used around the world, histology of nondysplastic BE, significance of goblet cells, grading of Barrett neoplasia, natural history of BE, bi... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558018 Wed, 31 Mar 2010 23:00:00 +0100 3558018 http://www.medworm.com/index.php?rid=3558017&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628831000015X%2Fabstract%3Frss%3Dyes Surveillance in the context of Barrett's esophagus (BE) implies follow-up endoscopy and biopsy of a patient with established BE. Therefore, we must have a clinical definition of BE, have criteria for which patients with BE should be surveyed, define the intervals of surveillance, and prescribe the biopsy protocol. There are no randomized trials of surveillance in BE, so evidence-based experts say not to survey. Whatever the documented value of surveillance, we need to identify the issues in the clinical context. The availability of effective, cost-effective, and safe ablation techniques for Barrett's neoplasia (dysplasia and early adenocarcinoma) provides an impetus to identify these neoplastic lesions to apply treatments to reduce the progression to cancer. The identification of treatable... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558017 Wed, 31 Mar 2010 23:00:00 +0100 3558017 http://www.medworm.com/index.php?rid=3558016&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000203%2Fabstract%3Frss%3Dyes Barrett's esophagus (BE) increases the risk for development of esophageal adenocarcinoma. Because of the rapid rise in incidence of esophageal adenocarcinoma, screening for BE with subsequent surveillance when found has been proposed as a method of early detection. Sedated endoscopy, however, is too expensive for widespread screening. As a result, other techniques, including unsedated transnasal esophagoscopy and capsule esophagoscopy, have been proposed to expand screening programs. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558016 Wed, 31 Mar 2010 23:00:00 +0100 3558016 http://www.medworm.com/index.php?rid=3558015&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000124%2Fabstract%3Frss%3Dyes Barrett's esophagus is an acquired condition resulting from severe esophageal mucosal injury. It is a disease that would be of little importance if not for its well-recognized association with adenocarcinoma of the esophagus. The incidence of esophageal adenocarcinoma continues to increase in the Western world, and the 5-year survival rate for this cancer remains dismal. Current strategies for improved survival in patients with esophageal adenocarcinoma focus on cancer detection at an early and potentially curable stage. This can be accomplished either by screening more patients for Barrett's esophagus or with endoscopic surveillance of patients with known Barrett's esophagus. However, current screening and surveillance strategies are inherently expensive, inefficient, and of unproven bene... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558015 Wed, 31 Mar 2010 23:00:00 +0100 3558015 http://www.medworm.com/index.php?rid=3558014&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000379%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558014 Wed, 31 Mar 2010 23:00:00 +0100 3558014 http://www.medworm.com/index.php?rid=3558013&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000367%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558013 Wed, 31 Mar 2010 23:00:00 +0100 3558013 http://www.medworm.com/index.php?rid=3558012&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000355%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558012 Wed, 31 Mar 2010 23:00:00 +0100 3558012 http://www.medworm.com/index.php?rid=3558011&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000343%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3558011 Wed, 31 Mar 2010 23:00:00 +0100 3558011 http://www.medworm.com/index.php?rid=3422327&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000069%2Fabstract%3Frss%3Dyes This article reviews and discusses the indications for, and techniques and outcomes of, endoscopic ampullectomy. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422327 Fri, 01 Jan 2010 00:00:00 +0100 3422327 http://www.medworm.com/index.php?rid=3422326&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000094%2Fabstract%3Frss%3Dyes Endoscopic ultrasound (EUS) has an important role in the staging of ampullary lesions. It affords excellent T staging when compared to cross sectional imaging. Several algorithms for the use of EUS in the assessment of ampullary lesions exist. This review details the comparison of different imaging modalities, impact of biliary stenting, cost-effectiveness and role of EUS in the assessment of ampullary lesions prior to endoscopic resection. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422326 Fri, 01 Jan 2010 00:00:00 +0100 3422326 http://www.medworm.com/index.php?rid=3422325&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000136%2Fabstract%3Frss%3Dyes Cryotherapy is a novel endoscopic method of ablating abnormal gastrointestinal (GI) mucosa with cryogens originating from either liquid nitrogen or carbon dioxide gas. The ablation is performed by passing a catheter through the accessory channel of an endoscope and the cryogen is sprayed onto the target tissue in a noncontact manner. Cell death is induced by producing extracellular ice. Recently, several reports have been published on the efficacy of cryotherapy for clinical use in the GI tract. In Barrett's esophagus, reports describe that cryotherapy was effective to eradicate or downgrade Barrett's associated dysplasia. Cryotherapy has also been reported to be useful for palliation of squamous cell carcinoma. Chronic recurrent bleeding from watermelon stomach (gastric antral vascular ec... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422325 Fri, 01 Jan 2010 00:00:00 +0100 3422325 http://www.medworm.com/index.php?rid=3422324&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000045%2Fabstract%3Frss%3Dyes Barrett's esophagus is a metaplastic complication of gastroesophageal reflux disease that predisposes to the development of adenocarcinoma of the esophagus. Treatment of the condition centers on acid suppression and prevention of progression to high-grade dysplasia or adenocarcinoma. Endoscopic ablation of the Barrett's mucosa, with reversion of intestinal metaplasia to squamous epithelium, may achieve the latter aim and can be performed using various modalities. There are many ablation options to eradicate the Barrett's mucosa. This review will focus on a review of the published data reporting ablation of Barrett's mucosa using argon plasma coagulation. This use of argon plasma coagulation for the ablation of Barrett's mucosa has previously been reviewed by Franchimont et al (Gastrointest... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422324 Fri, 01 Jan 2010 00:00:00 +0100 3422324 http://www.medworm.com/index.php?rid=3422323&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000100%2Fabstract%3Frss%3Dyes It may be questioned whether photodynamic therapy is still relevant for practicing gastroenterologists as other types of therapy have currently gained momentum. Important aspects of photodynamic therapy that continue its development are its intrinsic applicability to the luminal gastrointestinal tract where often there are areas of mechanical narrowing, unusual topography, and difficult accessibility where a modality that does not require contact or optical visualization has advantages. Although not used as often in the upper gastrointestinal tract for its original approved indications, such as esophageal cancer or Barrett's esophagus, its value in biliary lesions appears to be well substantiated. In this article, we will review its current application in the upper gastrointestinal tract. ... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422323 Fri, 01 Jan 2010 00:00:00 +0100 3422323 http://www.medworm.com/index.php?rid=3422322&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000082%2Fabstract%3Frss%3Dyes This article is a review of technical background of RFA using the HALO system and is a summary of the data on its current applications for the treatment of BE. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422322 Fri, 01 Jan 2010 00:00:00 +0100 3422322 http://www.medworm.com/index.php?rid=3422321&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000057%2Fabstract%3Frss%3Dyes The last decade has seen major advances in endoscopic therapy for mucosal neoplasia. Improvements in imaging, early lesion recognition and characterization and resection techniques have translated into substantial clinical gains. Endoscopic resection should now be seen as the primary means of treatment for early mucosal neoplasia in the digestive tract. This review will discuss the technical aspects and endoscopic approach for the most commonly used endoscopic resection techniques and highlight their clinical utility, major advantages and shortfalls as they are currently employed. A specific discussion of the technical aspects for two of the more commonly encountered problems in the western world, Barrett's oesophagus and duodenal polyps is presented. (Source: Techniques in Gastrointestina... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422321 Fri, 01 Jan 2010 00:00:00 +0100 3422321 http://www.medworm.com/index.php?rid=3422320&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000070%2Fabstract%3Frss%3Dyes Endoscopic ultrasonography is established as the most accurate modality for the local staging of esophageal neoplasms. The minimally invasive management of high-grade dysplasia and early intramucosal cancer arising in Barrett's esophagus is in evolution, with the emergence of endoscopically delivered ablative therapies challenging the more conventional treatment of esophagectomy. The precise staging of these patients for depth of tumor penetration, lymph node status, and potential hematogenous metastases, is therefore crucial before considering a minimally invasive treatment strategy. The evidence suggests that endoscopic ultrasonography can successfully differentiate early (T1) from advanced intramural disease, but it is poor at differentiating mucosal from submucosal lesions. Its role in... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422320 Fri, 01 Jan 2010 00:00:00 +0100 3422320 http://www.medworm.com/index.php?rid=3422319&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000033%2Fabstract%3Frss%3Dyes This article will review several endoscopic imaging techniques and technologies that have been developed to enhance the visualization of mucosal glandular and vascular changes associated with early neoplasia, including the use of chromoendoscopy using vital dyes and stains. Also, reviewed in this article are endoscopic innovations that have received regulatory approval, are commercially available, and are supported by controlled clinical studies confirming their utility, such as high-resolution endoscopy and “virtual chromendoscopy” using narrow band imaging. The use of confocal laser endomicroscopy will be discussed, as this device provides real-time, histology-like information of cellular and vascular architecture. These technologies move us closer to the reality of an “optical bio... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422319 Fri, 01 Jan 2010 00:00:00 +0100 3422319 http://www.medworm.com/index.php?rid=3422318&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000021%2Fabstract%3Frss%3Dyes One of the great attractions of the practice of endoscopy is that it is constantly changing and challenging previous paradigms. An excellent example of this is the role of endoscopy in the management of early neoplasia of the upper gastrointestinal tract. Great advances in endoscopic imaging and therapy have occurred in this area in the past 10 years, and so it is timely to review the current status of endoscopy for these conditions. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422318 Fri, 01 Jan 2010 00:00:00 +0100 3422318 http://www.medworm.com/index.php?rid=3422317&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000240%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422317 Fri, 01 Jan 2010 00:00:00 +0100 3422317 http://www.medworm.com/index.php?rid=3422316&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000239%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422316 Fri, 01 Jan 2010 00:00:00 +0100 3422316 http://www.medworm.com/index.php?rid=3422315&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000227%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422315 Fri, 01 Jan 2010 00:00:00 +0100 3422315 http://www.medworm.com/index.php?rid=3422314&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288310000215%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3422314 Fri, 01 Jan 2010 00:00:00 +0100 3422314 http://www.medworm.com/index.php?rid=3086614&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000862%2Fabstract%3Frss%3Dyes This article summarizes the current regulatory environment in which OBS/OBA practices and practitioners must operate. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086614 Thu, 01 Oct 2009 00:00:00 +0100 3086614 http://www.medworm.com/index.php?rid=3086613&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000850%2Fabstract%3Frss%3Dyes Office-based anesthesiology (OBA) presents an opportunity for some anesthesiology practices to expand their scope and garner professional and financial growth opportunities. Practices that center their OBA feasibility analysis on their mission and objectives stand to be the most successful whether or not they decide to pursue an OBA venture. The steps in evaluating the risk/benefit of entry into OBA include a complete analysis of the anesthesiology practice's mission and resources, and an evaluation of the prospective office site to assure it offers a safe and financially viable practice venue. An effective OBA implementation plan deals with the attendant legal and regulatory requirements, a client satisfaction program, and development of an administrative infrastructure to support and mon... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086613 Thu, 01 Oct 2009 00:00:00 +0100 3086613 http://www.medworm.com/index.php?rid=3086612&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000825%2Fabstract%3Frss%3Dyes Anesthesia providers increasingly find their services requested in endoscopy suites. There are numerous reasons, but the single most common factor is the increasing use of propofol. Despite clear trends indicating a greater demand for services, the safety record of out-of-operating room (OR) locations falls short of that in the OR. A variety of skills are required in the endoscopy suite, some of which are found in the core material of anesthesia training programs, and others that are not stressed in importance. The purpose of this article is to examine the methods of training that might be useful in producing anesthesia providers prepared for the challenges of the endoscopy suite and other out-of-OR locations, and speculate on how anesthesia training directors might address these needs. (S... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086612 Thu, 01 Oct 2009 00:00:00 +0100 3086612 http://www.medworm.com/index.php?rid=3086611&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000813%2Fabstract%3Frss%3Dyes Spontaneous breathing is the default mode of ventilation for procedures in gastrointestinal (GI) endoscopy. Sedative–hypnotic medications profoundly impair respiratory control and airway patency. Fundamental physiology of hypoventilation is reviewed in the context of the patient presenting for interventional endoscopy. The endoscopy setting presents unique challenges for airway management and ventilation. These include a shared airway, patient-positioning, and out-of-Operating Room location. Strategies to support airway patency, oxygenation, and ventilation that are commonly employed in the controlled setting of the operating room can be effectively adapted to the GI endoscopy suite. Techniques discussed include nasal airway devices/CPAP, pressure-support ventilation, jet ventilation, an... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086611 Thu, 01 Oct 2009 00:00:00 +0100 3086611 http://www.medworm.com/index.php?rid=3086610&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000783%2Fabstract%3Frss%3Dyes Respiratory obstruction is a frequent consequence of sedation due to the collapsibility of the velopharynx. Several approaches are available to eliminate this obstruction, including CPAP, mandibular advancement, nasal airways, and laryngeal mask airways. Practical approaches to the use of these measures are described. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086610 Thu, 01 Oct 2009 00:00:00 +0100 3086610 http://www.medworm.com/index.php?rid=3086609&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000837%2Fabstract%3Frss%3Dyes The control of administration of drugs such as propofol is a task that is difficult to master. Two approaches to this task have emerged—target-controlled infusion, and patient-controlled sedation. In the first, a set point for drug in a hypothetical effect site is specified, and the controller delivers drug to hold the predicted concentration at that level. In the second, the patient administers small boluses of drug to maintain comfort. The theoretical basis of these approaches will be reviewed, available technology presented, and practical use of these devices discussed. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086609 Thu, 01 Oct 2009 00:00:00 +0100 3086609 http://www.medworm.com/index.php?rid=3086608&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000795%2Fabstract%3Frss%3Dyes This is a review of basic principles applicable to the use of propofol by trained endoscopists and nurses for endoscopy, without the involvement of an anesthesia specialist (an anesthesiologist or certified registered nurse anesthetist). The review also explicitly describes the nature of the current controversy surrounding the use of propofol by endoscopists, implies its origins in financial incentives, and outlines obstacles to the use of endoscopist-directed propofol. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086608 Thu, 01 Oct 2009 00:00:00 +0100 3086608 http://www.medworm.com/index.php?rid=3086607&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000801%2Fabstract%3Frss%3Dyes Most endoscopic procedures in the USA are performed with some form of conscious sedation. The typical practice of midazolam and fentanyl is being supplanted by newer agents, including propofol, fospropofol, ketamine, and dexmedetomidine. These agents offer various advantages; propofol has significantly faster onset and offset, fospropofol avoids the problems associated with the lipid emulsion of propofol, and ketamine and dexmedetomidine avoid the respiratory depression associated with other sedatives. Understanding the properties of these agents may improve patient outcomes during endoscopy. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086607 Thu, 01 Oct 2009 00:00:00 +0100 3086607 http://www.medworm.com/index.php?rid=3086606&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000771%2Fabstract%3Frss%3Dyes This chapter is concerned with “extended monitoring” and “advanced sedation” in gastroenterology. Topics discussed include capnography, monitoring depth of sedation, and computer-assisted propofol sedation. Although classical “hands-on” and “eyes-on” monitoring methods remain indispensable in monitoring patients undergoing gastrointestinal (GI) endoscopic procedures, some newer monitoring technologies are proving to be useful as well and are discussed. The chapter begins by examining the role that capnography plays in the respiratory monitoring of unintubated patients receiving sedation. Sample capnographic waveforms are provided and the results of recent GI capnographic studies are summarized. The discussion then switches to electronic processing of the electroencephalogra... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086606 Thu, 01 Oct 2009 00:00:00 +0100 3086606 http://www.medworm.com/index.php?rid=3086605&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000849%2Fabstract%3Frss%3Dyes There is little question that the state of play in sedation for endoscopic procedures is in considerable flux. The epidemic of morbid obesity, the aging of the baby boom generation, and improved technology for early detection of colon and esophageal cancer have increased the volume and acuity of procedures as continuing pressure to contain costs have increased pressure to improve efficiency. Improvements in efficiency in procedural sedation can be significant, particularly in high-volume centers, but many anesthesia departments are inadequately staffed for out-of-operating room coverage, and trends in reimbursement portend a retreat from endoscopy by anesthesiologists. Battles over control of propofol have erupted. Clearly, this is hostile territory into which only brave scouts should trea... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086605 Thu, 01 Oct 2009 00:00:00 +0100 3086605 http://www.medworm.com/index.php?rid=3086604&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000916%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086604 Thu, 01 Oct 2009 00:00:00 +0100 3086604 http://www.medworm.com/index.php?rid=3086603&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000904%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086603 Thu, 01 Oct 2009 00:00:00 +0100 3086603 http://www.medworm.com/index.php?rid=3086602&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000886%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086602 Thu, 01 Oct 2009 00:00:00 +0100 3086602 http://www.medworm.com/index.php?rid=3086601&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000874%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=3086601 Thu, 01 Oct 2009 00:00:00 +0100 3086601 http://www.medworm.com/index.php?rid=2822060&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000485%2Fabstract%3Frss%3Dyes Transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) enables minimally invasive tissue sampling of mediastinal lymph nodes. There is convincing evidence that EUS-FNA is an accurate method for mediastinal staging of patients with non small cell lung cancer (NSCLC), and therefore EUS-FNA provides an alternative for surgical evaluation of the mediastinum. Due to the complementary reach in analyzing different mediastinal regions, additional staging by EUS-FNA to mediastinoscopy improves preoperative staging of NSCLC and therefore reduces the number of futile thoracotomies. Preliminary data suggest an important role for EUS-FNA in the assessment of mediastinal tumor invasion as well as mediastinal restaging after prior chemo (radiation) therapy. For interstitial lung diseases, EUS... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822060 Tue, 30 Jun 2009 23:00:00 +0100 2822060 http://www.medworm.com/index.php?rid=2822059&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000345%2Fabstract%3Frss%3Dyes Although the exact incidence of nonbronchogenic endobronchial metastatic (EBM) disease is unknown, it appears a rare cause of central airway obstruction. It is likely that nonpulmonary endobronchial metastases are underdiagnosed, as many patients with known or suspected lung parenchymal metastases do not undergo bronchoscopy as part of their clinical evaluation. Colorectal carcinoma, the third most common cancer, remains a predominant cause of nonlung EBM. Other gastrointestinal tumors (gastric, pancreatic, hepatocellular, ampullary, and esophageal carcinoma) are also known to metastasize to the central airways. A high index of suspicion must be maintained for the possibility of EBM in patients with known metastatic disease elsewhere, as the symptoms may be subtle. Bronchoscopy offers the ... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822059 Tue, 30 Jun 2009 23:00:00 +0100 2822059 http://www.medworm.com/index.php?rid=2822058&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000333%2Fabstract%3Frss%3Dyes This article aims to discuss the benefits derived from using EBUS in the diagnosis, staging, and treatment of gastrointestinal malignancies. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822058 Tue, 30 Jun 2009 23:00:00 +0100 2822058 http://www.medworm.com/index.php?rid=2822057&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000369%2Fabstract%3Frss%3Dyes Pulmonary complications of inflammatory bowel disease (IBD) have been increasingly recognized and reported in the literature. The complications can involve the lung parenchyma, pleural space, and small or large airways. Although the mechanism of pulmonary involvement in IBD is not clearly understood, there are pathological similarities between the disease seen in the lungs and that in the bowel. Accurate diagnosis involves a combination of patient history, symptom review, thoracic imaging modalities, and bronchoscopic evaluation. We will summarize the various IBD-associated pulmonary complications, and specifically focus on reviewing the airway manifestations that have been reported. Endoscopic management strategies which include rigid or balloon dilatation, laser therapy, electrocautery, ... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822057 Tue, 30 Jun 2009 23:00:00 +0100 2822057 http://www.medworm.com/index.php?rid=2822056&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000357%2Fabstract%3Frss%3Dyes The development of trachea- or broncho-esophageal fistulae is a devastating thoracic malignancy complication leading to increased morbidity and mortality due to pneumonia, sepsis, and malnutrition. Due to this high morbidity and mortality, attempts to close or cover the fistula are often undertaken. Multiple modalities have been evaluated and reported to treat malignant aerodigestive fistulae (MAF), although no single approach has become the standard of care. The American College of Chest Physicians recommends palliative stenting for MAF, but this approach may not be effective depending on size, configuration, and position of the fistula. This manuscript will critically evaluate the role of single airway stenting or double airway and esophageal stenting in MAF palliation. We will recommend... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822056 Tue, 30 Jun 2009 23:00:00 +0100 2822056 http://www.medworm.com/index.php?rid=2822055&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000321%2Fabstract%3Frss%3Dyes Hepatic hydrothorax (HH) is a troublesome pulmonary complication that can arise in end-stage liver disease patients and can significantly impair patient quality of life and functional ability. The presence of portal hypertension, the accumulation of ascites, and subsequent fluid translocation through diaphragmatic fenestrations underlies this complication. Other pleural effusion etiologies must be excluded to ensure alternative diagnoses are not the pleural effusion source. Once attributed to HH, management and an optimal patient outcome can be difficult to achieve. This review will discuss the current understanding and various approaches to HH management, with a focus on intrathoracic interventions for this vexing clinical problem. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822055 Tue, 30 Jun 2009 23:00:00 +0100 2822055 http://www.medworm.com/index.php?rid=2822054&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000473%2Fabstract%3Frss%3Dyes Pulmonary medicine and Gastroenterology are similar disciplines which involve the study of a specific organ system which can be affected by either disorders unique to that organ system or by systemic diseases that have secondary effects upon the target organs. Both disciplines rely upon a broad knowledge of internal medicine, superb diagnostic instincts, and technical expertise in the performance of diagnostic and therapeutic endoscopic procedures. Gastrointestinal endoscopy leapfrogged ahead of pulmonary endoscopy in the 1970s, buoyed by the indications for screening sigmoidoscopy, colonoscopy and esophagoscopy, as well by the technical advancements in endoscope design and accessories that enabled the development of advanced diagnostic and therapeutic procedures such as endoscopic retrogr... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822054 Tue, 30 Jun 2009 23:00:00 +0100 2822054 http://www.medworm.com/index.php?rid=2822053&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000527%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822053 Tue, 30 Jun 2009 23:00:00 +0100 2822053 http://www.medworm.com/index.php?rid=2822052&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000515%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822052 Tue, 30 Jun 2009 23:00:00 +0100 2822052 http://www.medworm.com/index.php?rid=2822051&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000503%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822051 Tue, 30 Jun 2009 23:00:00 +0100 2822051 http://www.medworm.com/index.php?rid=2822050&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000497%2Fabstract%3Frss%3Dyes (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2822050 Tue, 30 Jun 2009 23:00:00 +0100 2822050 http://www.medworm.com/index.php?rid=2771074&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000461%2Fabstract%3Frss%3Dyes The foundation of skills for the performance of natural orifice translumenal endoscopic surgery (NOTES) lies in the training for general surgery (especially laparoscopy) and flexible gastrointestinal endoscopy. Physicians wishing to practice NOTES need to acquire or have both skill sets, or need to partner together to blend complementary capabilities with colleagues. It is anticipated that NOTES, as currently practiced, will be performed in a team approach with surgeons and gastroenterologists participating. In the future, however, a new cadre of NOTES specialists may emerge who will have developed individual expertise in the full spectrum of NOTES knowledge base requirements. In the context of current surgical and gastroenterology training, this means that surgeons must gain mastery in ba... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771074 Tue, 31 Mar 2009 23:00:00 +0100 2771074 http://www.medworm.com/index.php?rid=2771073&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628830900045X%2Fabstract%3Frss%3Dyes In little more than a decade, exploring the abdominal cavity through natural orifices has progressed from a fantastic idea to the first tentative applications in a human series. The next phase should be one of rigorous testing of the feasibility and value of the many proposed innovative techniques and applications. Without such careful evaluation, some procedures may well be applied inappropriately, to the detriment of the patients, and others may never reach their clinical potential. It is essential that the necessary studies should be based soundly on established scientific principles, and be designed and conducted well. Trials of poor quality can be destructive to a field. They can create both inappropriate skepticism and overoptimism, and may complicate recruitment for future or ongoin... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771073 Tue, 31 Mar 2009 23:00:00 +0100 2771073 http://www.medworm.com/index.php?rid=2771072&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628830900031X%2Fabstract%3Frss%3Dyes This article will present and discuss the differences of the technique when compared with laparoscopy, the different models of single trocar devices and the literature available on this matter. Authors experience with single incision, multiple trocars and single trocar procedures comes from 21 consecutive single incision, multiple trocars cholecystectomies and 25 single trocar cholecystectomies from 2008 to 2009 (retrospective analysis). Single incision group had 16 female patients within 22 to 58y (M = 42 y), single port group had 19 female patients within 26 to 60 y (M = 44 y). Operative time was 32 to 100 min (M = 59 min) and 32 to 205 min (M = 85.2 min) respectively. Intra-op complication happened as 1 cystic artery bleeding on single access group. Post-op complication appears as 2 ser... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771072 Tue, 31 Mar 2009 23:00:00 +0100 2771072 http://www.medworm.com/index.php?rid=2771071&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000278%2Fabstract%3Frss%3Dyes This article discusses technical aspects, human casuistic, and rationale of natural orifice translumenal endoscopic surgery (NOTES) vaginal access. Vaginal access can be performed by direct vision using conventional instruments or by first introduction of an umbilical laparoscope to visualize the introduction of a transvaginal trocar. Insufflation through the endoscope’s channel should be avoided and preferentially achieved by transvaginal insufflation, Veress needle, or laparoscopic trocar. Abdominal procedures may be approached transvaginally classified as Totally NOTES, Hybrid NOTES, NOTES-assisted laparoscopy, or using natural orifice only for specimen extraction (NOSE). Vaginal wound is usually closed with absorbable sutures under direct vision using conventional instruments. Vagina... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771071 Tue, 31 Mar 2009 23:00:00 +0100 2771071 http://www.medworm.com/index.php?rid=2771070&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000254%2Fabstract%3Frss%3Dyes Over the past 100 years, there has been a gradual progression in the field of surgery from the traditional invasive open laparotomy to increasingly less invasive techniques of laparoscopy. In contrast, the field of gastrointestinal endoscopy has become increasing more interventional, with therapeutic endoscopists performing procedures previously only performed by surgeons, including transgastric pseudocyst drainage and transgastric endoscopic pancreatic debridement. Natural orifice translumenal endoscopic surgery (NOTES) appears to represent a convergence of the two fields of minimally invasive surgery and interventional endoscopy. NOTES is the performance of intra-abdominal interventions via an incisional opening through a natural orifice. Although initial studies were focused on the tran... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771070 Tue, 31 Mar 2009 23:00:00 +0100 2771070 http://www.medworm.com/index.php?rid=2771069&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS109628830900028X%2Fabstract%3Frss%3Dyes Natural orifice translumenal endoscopic surgery (NOTES) has been the focus of extensive research since the first NOTES procedure was reported in 2004 by Kalloo and colleagues. Although a number of animal experiments and some human experiences of NOTES have been reported in the last few years, there are many issues that need to be addressed before this technique is adopted widely in clinical practice. Achieving a safe and effective access to the peritoneal cavity at an optimal location using most favorable techniques was the foremost barrier. So far, transgastric, transrectal, transvaginal, and transurethral approaches have been reported as potential access routes to the peritoneal cavity, of which the transgastric route has been one of the most widely studied. Although the transgastric rou... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771069 Tue, 31 Mar 2009 23:00:00 +0100 2771069 http://www.medworm.com/index.php?rid=2771068&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000266%2Fabstract%3Frss%3Dyes Interest in natural orifice translumenal endoscopic surgery (NOTES) within the thoracic cavity and the mediastinum is gaining momentum. The experience obtained from minimal invasive surgery suggests that the elimination of external incisions might potentially reduce the high morbidity of thoracic surgery associated with a thoracotomy and sternotomy by performing mediastinal and thoracic interventions through the esophagus. A variety of endoscopic transesophageal access techniques have been developed to approach mediastinal and thoracic structures such as full-thickness incision of the esophageal wall, submucosal tunneling, and endoscopic ultrasound-guided access. Initial experimental animal studies have shown that these NOTES techniques are feasible and potentially safe, opening a new aren... Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771068 Tue, 31 Mar 2009 23:00:00 +0100 2771068 http://www.medworm.com/index.php?rid=2771067&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000291%2Fabstract%3Frss%3Dyes The best way to predict the future is to invent it.Alan Kay b. 1940 You may ask why this issue of Techniques in Gastrointestinal Endoscopy is dedicated to NOTES. The simple answer is that NOTES is the next frontier for gastrointestinal endoscopists. NOTES evolved using the principles and tools of therapeutic flexible endoscopy. Furthermore, developing the tools for NOTES will improve our standard therapeutic endoscopic procedures enabling further interventions within the gastrointestinal lumen. Although NOTES is still considered to be in the nascent stages of development, under the guidance of NOSCAR (Natural Orifice Surgery Consortium for Assessment and Research) and other working groups, much progress has been made in the last 5 years. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771067 Tue, 31 Mar 2009 23:00:00 +0100 2771067 http://www.medworm.com/index.php?rid=2771066&cid=s_38675_17_f&fid=38675&url=http%3A%2F%2Fwww.techgiendoscopy.com%2Farticle%2FPIIS1096288309000308%2Fabstract%3Frss%3Dyes This volume of Techniques in Gastrointestinal Endoscopy is edited by Dr. Anthony Kalloo, who is well-known for his pioneering work in therapeutic endoscopy and NOTES. His vision is a perfect example of the innovation that is needed to move Gastroenterology forward. Some may clearly not be comfortable performing, or even contemplating, some of the procedures that are embodied within NOTES, but knowledge and understanding of the techniques and technologies embodied are critical. NOSCAR (formed as a collaboration of the ASGE and SAGES) has selected over 50 research projects to receive approximately $2,000,000 in funding to further explore the feasibility of this platform and to aid in development and assessment of the concept. (Source: Techniques in Gastrointestinal Endoscopy) Techniques in Gastrointestinal Endoscopy journals http://www.medworm.com/rss/comments.php?id=2771066 Tue, 31 Mar 2009 23:00:00 +0100 2771066