Targarona Modena, Javier; Rosamedina, Jose Luis; Garatea, Rafael; Romero, Cesar; Lora, Alfonso; Contardo, Carlos; Mantila, Lidia; Yabar, Alejandro; Montoya, Eduardo
The Vater's ampulla neoplasias are not very frequent lesions. The ampullectomy consists on the total resection of the Vater's ampulla and part of the duodenal wall with the later reconstruction and anastomosis of the common bile duct and the Wirsung's duct to the duodenum. The local resection of the ampulla is an alternative to the duodenopancreatectomy that has to be taken into account, especially in benign lesions as in the case of adenomas of the Vater's ampulla. Here we describe two cases one with adenoma of the Vater's ampulla, with a high degree dysplasia, who first underwent an ampullectomy and finally ended up in a duodenopancreatectomy due to the infiltration of the adenoma into the edge of section and other case of Lymphangioma of Vater's ampulla with no infiltration in the edge of section.
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... because experience with it is limited and traditional upper endoscopy is widely available. Your doctor might recommend a capsule endoscopy procedure to: Find the cause of gastrointestinal bleeding. If you have unexplained bleeding in your digestive ...
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Full Text Available The need for emergency endoscopy is a matter of debate. The time interval for emergency procedures remains to be defined. Most authors propose a time span of 24 h as emergency time, while some define a period of 72 h (especially in acute pancreatitis. Several studies have shown a possible benefit for a select group of patients. Four main indications are established for emergency endoscopy: acute gastrointestinal bleeding (variceal and nonvariceal, acute biliary pancreatitis and acute cholangitis. In the case of upper gastrointestinal bleeding, emergency endoscopy enables exact diagnosis and appropiate therapy, and provides important prognostic information. There is some evidence that emergent endoscopic injection therapy improves clinical outcome and reduces mortality in patients with acute ulcer bleeding. Patients do not benefit if endoscopy is performed only as a diagnostic procedure. Controversial results were published recently for emergency endoscopy in acute biliary pancreatitis. There is good evidence that emergency endoscopic retrograde cholangiopancreatography is helpful in patients with severe pancreatitis and stone impaction if performed within the first 24 h after onset of symptoms. However, emergency endoscopic retrograde cholangiopancreatography is not benefical for patients with mild pancreatitis if performed later than 72 h (or 24 h after onset of symptoms. There is a limited number of well established evidence-based indications for emergency endoscopy. Some other indications are still a matter of debate, and controversial opinions have been published.
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Skovsen, Anders Peter; Burcharth, Jakob; Burgdorf, Stefan Kobbelgaard
with ultrasound, MRI, and subsequently a capsule endoscopy. Six months later, the patient presented, and an abdominal CT-scan showed mechanical small bowel obstruction with suspicion of metallic foreign body and perforation. Laparotomy showed perforation, stenosis, and foreign body, approximately 5 cm from...... the ileocecal valve. A right hemicolectomy and distal ileectomy (60 cm) with an ileostomy were performed. On further inspection of resection, a capsule endoscope was found impacted in a stenosis. The ileostomy was later reversed without complications. Conclusion. It is important to be aware of the possibility...... of capsule retention, especially in patients with known or suspected Crohn's disease, due to the propensity of Crohn's disease to form stenosis of the bowel. In cases where a stenosis is suspected, it is warranted to perform a patency capsule swallow before subjecting the patient to a capsule endoscopy....
Capsule endoscopy (CE) is a simple, safe, non-invasive, reliable technique, well accepted and tolerated by the patients, which allows complete exploration of the small intestine. The advent of CE in 2000 has dramatically changed the diagnosis and management of many diseases of the small intestine, such as obscure gastrointestinal bleeding, Crohn's disease, small bowel tumors, polyposis syndromes, etc. CE has become the gold standard for the diagnosis of most diseases of the small bowel. Lately this technique has also been used for esophageal and colonic diseases.
Schroeder, H W; Gaab, M R
The authors' intention is to reduce the invasiveness of intracranial procedures while avoiding traumatization of brain tissue, to decrease the risk of neurological and mental deficits. Intracranial endoscopy is a minimally invasive technique that provides rapid access to the target via small burr holes without the need for brain retraction. Craniotomy as well as microsurgical brain splitting and dissection can often be avoided. Furthermore, because obstructed cerebrospinal fluid pathways can be physiologically restored, the need for shunt placement is eliminated. The ventricular system and subarachnoid spaces provide ideal conditions for the use of an endoscope. Therefore, a variety of disorders, such as hydrocephalus, small intraventricular lesions, and arachnoid and parenchymal cysts can be effectively treated using endoscopic techniques. With the aid of special instruments, laser fibers, and bipolar diathermy, even highly vascularized lesions such as cavernomas may be treated. Moreover, during standard microsurgical procedures, the endoscopic view may provide valuable additional information ("looking around a corner") about the individual anatomy that is not visible with the microscope. In transsphenoidal pituitary surgery, transseptal dissection can be avoided if an endonasal approach is taken. In the depth of the intrasellar space, the extent of tumor removal can be more accurately controlled, especially in larger tumors with para- and suprasellar growth. The combined use of endoscopes and computerized neuronavigation systems increases the accuracy of the approach and provides real-time control of the endoscope tip position and approach trajectory. In the future, the indications for neuroendoscopy will certainly expand with improved technical equipment.
Ignacio Fernandez-Urien; Cristina Carretero; Raul Armendariz; Miguel Mu(n)oz-Navas
Capsule endoscopy is now considered as the first imaging tool for small bowel examination.Recently,new capsule endoscopy applications have been developed,such as esophageal capsule endoscopy and colon capsule endoscopy.Esophageal capsule endoscopy in patients with suspected esophageal disorders is feasible and safe,and could be also an alternative procedure in those patients refusing upper endoscopy.Although large-scale studies are needed to confirm its utility in GERD and cirrhotic patients,current results are encouraging and open a new era in esophageal examination.
Raúl Fuentes Navarro
Full Text Available El siguiente apartado es el producto de una mesa redonda denominada Experiencias editoriales en revistas académicas multidisciplinares, que se verificó el viernes 19 de marzo de 2004 en el Museo Regional de Historia de la ciudad de Colima. En ella participaron varios coordinadores y miembros de los consejos editoriales de publicaciones académicas de la Universidad de Colima para ofrecernos sus experiencias en este rubro. La mesa surgió bajo la necesidad de compartir frente a un grupo de pares los problemas centrales de revistas de este tipo en México. La reflexión giro en torno a las circunstancias específicas en las que se producen las revistas académicas, se revisaron sus problemáticas, sus limitantes y se compartieron estrategias para potenciar la gestión de recursos.
Full Text Available Experiencia Centelles es un itinerario por los escenarios de las fotografías de Agustí Centelles i Ossó (1909-1985 realizadas en Barcelona, el primer día de la Guerra Civil Española. Una detallada y rigurosa investigación previa por parte del autor de esta comunicación, habilita a los asistentes a esta ruta para reconstruir, a través de su propia experiencia, los hechos representados en los mismos lugares donde éstos se produjeron. Esto les permite acceder a una información que, si bien re- side en las imágenes, no se desvela mientras no son observadas en su contexto espacial original. Es entonces cuando el observador puede adquirir, de primera mano, unos conocimientos históricos e incluso técnicos, sobre las condiciones en que las fotografías fueron realizadas. Esta percepción capacita al observador para ejercer una mirada crítica sobre el paisaje, la historia y las imágenes que los representan. El presente artículo propone una lectura de esta experiencia en un contexto arqueológico, es decir, desde el análisis de las fotografías in situ, en tal que restos de los acontecimientos de los que, en su momento, formaron parte.
@@ Endoscopy has gained fame and acceptance due to its proven value in its diagnostic and therapeutic aspects. Quality levels of endoscopy practice has been benchmarked as the the only way to maximize the benefits of this wonderful medical innovation.
Ignacio Fernandez-Urien; Cristina Carretero; Ana Borda; Miguel Mu(n)oz-Navas
Wireless capsule endoscopy has become the first imaging tool for small bowel examination.Recently,new capsule endoscopy applications have been developed,such as esophageal capsule endoscopy and colon capsule endoscopy.Clinical trials results have shown that colon capsule endoscopy is feasible,accurate and safe in patients suffering from colonic diseases.It could be a good alternative in patients refusing conventional colonoscopy or when it is contraindicated.Upcoming studies are needed to demonstrate its utilty for colon cancer screening and other indications such us ulcerative colitis.Comparative studies including both conventional and virtual colonoscopy are also required.
José Ruiz Valerio
Full Text Available Los objetivos del trabajo son: 1 analizar algunas de las principales aportaciones teóricas acerca del presidencialismo de coalición en Amé- rica Latina; 2 analizar las principales características de los gobiernos de coalición bajo sistemas presidenciales, a partir de la experiencia de 11 países de América Latina, proponiendo algunos rasgos comunes que puedan ayudar a definir al presidencialismo de coalición como modelo político; 3 analizar la relación existente entre el presidencialismo y la organización territorial del poder (unitaria o federal en dichos países; 4 analizar el impacto que la organización territorial del poder posee sobre la construcción de coaliciones presidenciales de gobierno; 5 proponer algunas conclusiones que puedan servir de base a nuevos estudios sobre el tema.
Daphnée Beaulieu; Alan N Barkun; Catherine Dubé; Jill Tinmouth; Pierre Hallé; Myriam Martel
OBJECTIVES: The Canadian Association of Gastroenterology (CAG) recently published consensus recommendations for safety and quality indicators in digestive endoscopy. The present article focuses specifically on the identification of key elements that should be found in all electronic endoscopy reports detailing recommendations adopted by the CAG consensus group.METHODS: A committee of nine individuals steered the CAG Safety and Quality Indicators in Endoscopy Consensus Group, which had a total...
Lee, Myung Chul
It is more difficult to achieve cooperation when conducting endoscopy in pediatric patients than adults. As a result, the sedation for a comfortable procedure is more important in pediatric patients. The sedation, however, often involves risks and side effects, and their prediction and prevention should be sought in advance. Physicians should familiarize themselves to the relevant guidelines in order to make appropriate decisions and actions regarding the preparation of the sedation, patient monitoring during endoscopy, patient recovery, and hospital discharge. Furthermore, they have to understand the characteristics of the pediatric patients and different types of endoscopy. The purpose of this article is to discuss the details of sedation in pediatric endoscopy.
Full Text Available Different anesthetic techniques and drugs can be used for esophagogastroduedonal endoscopy. However, the scientists are still searching for appropriate drugs and protocols for sedation during esophagogastroduedonal endoscopy. The aim of this review is to discuss the topics related with sedation and esophagogastroduedonal endoscopy in the light of literature. Today standard procedure for diagnostic esophagogastroduedonal endoscopy usually consists of topical pharyngeal anesthesia, minimal sedation or anxiolysis, which may be complemented with analgesia when needed. When a prolonged, complex, or particularly troublesome or painful examination is foreseen, deeper sedation with multiple drugs and in closed observation of a staff may be required.
Despite advances in exotic animal endoscopy, descriptions involving amphibians are scarce. Amphibian endoscopy shares some similarities with reptiles, especially in lizards. Selected procedures are discussed, including stomatoscopy, gastroscopy, coelioscopy, and biopsy of coelomic organs and lesions. This short overview provides the practitioner with pragmatic advice on how to conduct safe and effective endoscopic examinations in amphibians.
Endoscopy is rarely required during pregnancy. The potential risks of endoscopy during pregnancy include foetal hypoxia due to sedative drugs and exposure to radiation. There is no evidence that endoscopy precipitates premature labour, and studies in this area have concluded that endoscopy during pregnancy is generally safe. There should be a strong indication for the procedure, which should be deferred whenever possible to the second trimester. Procedures should be performed without any sedation, or with the lowest dose of sedative medication. Radiation exposure should be kept to a minimum. Support should be obtained from specialists in obstetrics and anaesthesia. Indications for endoscopy during pregnancy are as follows: (1) gastroscopy: upper gastrointestinal bleeding, dysphagia, uncontrolled nausea\\/vomiting; (2) sigmoidoscopy\\/colonoscopy: rectal bleeding, diarrhoea; and (3) ERCP: choledocholithiasis, biliary pancreatitis. Sedative drugs, such as midazolam appear to be safe if used carefully. Radiation exposure during ERCP can be kept well below the danger level for teratogenicity.
... to diagnose conditions such as cancer celiac disease gastritis Doctors also use upper GI endoscopy to treat ... Bhutani MS. Esophagogastroduodenoscopy. Medscape website. emedicine.medscape.com/article/1851864-overview#a17 . Updated June 3, 2013. Accessed ...
Klibansky, David; Rothstein, Richard I
The increasing complexity of intralumenal and emerging translumenal endoscopic procedures has created an opportunity to apply robotics in endoscopy. Computer-assisted or direct-drive robotic technology allows the triangulation of flexible tools through telemanipulation. The creation of new flexible operative platforms, along with other emerging technology such as nanobots and steerable capsules, can be transformational for endoscopic procedures. In this review, we cover some background information on the use of robotics in surgery and endoscopy, and review the emerging literature on platforms, capsules, and mini-robotic units. The development of techniques in advanced intralumenal endoscopy (endoscopic mucosal resection and endoscopic submucosal dissection) and translumenal endoscopic procedures (NOTES) has generated a number of novel platforms, flexible tools, and devices that can apply robotic principles to endoscopy. The development of a fully flexible endoscopic surgical toolkit will enable increasingly advanced procedures to be performed through natural orifices. The application of platforms and new flexible tools to the areas of advanced endoscopy and NOTES heralds the opportunity to employ useful robotic technology. Following the examples of the utility of robotics from the field of laparoscopic surgery, we can anticipate the emerging role of robotic technology in endoscopy.
Jian-Guo Zhang; Hai-Feng Liu
The emergence of endoscopy for the diagnosis of gastrointestinal diseases and the treatment of gastrointestinal diseases has brought great changes.The mere observation of anatomy with the imaging mode using modern endoscopy has played a significant role in this regard.However,increasing numbers of endoscopies have exposed additional deficiencies and defects such as anatomically similar diseases.Endoscopy can be used to examine lesions that are difficult to identify and diagnose.Early disease detection requires that substantive changes in biological function should be observed,but in the absence of marked morphological changes,endoscopic detection and diagnosis are difficult.Disease detection requires not only anatomic but also functional imaging to achieve a comprehensive interpretation and understanding.Therefore,we must ask if endoscopic examination can be integrated with both anatomic imaging and functional imaging.In recent years,as molecular biology and medical imaging technology have further developed,more functional imaging methods have emerged.This paper is a review of the literature related to endoscopic optical imaging methods in the hopes of initiating integration of functional imaging and anatomical imaging to yield a new and more effective type of endoscopy.
Friedt, Michael; Welsch, Simon
Advances in endoscopy and anesthesia have enabled gastrointestinal endoscopy for children since 1960. Over the past decades, the number of endoscopies has increased rapidly. As specialized teams of pediatric gastroenterologists, pediatric intensive care physicians and pediatric endoscopy nurses are available in many medical centers, safe and effective procedures have been established. Therefore, diagnostic endoscopies in children are routine clinical procedures. The most frequently performed endoscopies are esophagogastroduodenoscopy (EGD), colonoscopy and endoscopic retrograde cholangiopancreaticography (ERCP). Therapeutic interventions include variceal bleeding ligation, foreign body retrieval and percutaneous endoscopic gastrostomy. New advances in pediatric endoscopy have led to more sensitive diagnostics of common pediatric gastrointestinal disorders, such as Crohn's disease, ulcerative colitis and celiac disease; likewise, new diseases, such as eosinophilic esophagitis, have been brought to light.Upcoming modalities, such as capsule endoscopy, double balloon enteroscopy and narrow band imaging, are being established and may contribute to diagnostics in pediatric gastroenterology in the future.
Recently, Indonesia was ranked as the fourth most populous country in the world. Based on 2012 data, 85000 general practitioners and 25000 specialists are in service around the country. Gastrointestinal (GI) disease remains the most common finding in daily practise, in both outpatient and inpatient settings, and ranks fifth in causing mortality in Indonesia. Management of patients with GI disease involves all health-care levels with the main portion in primary health care. Some are managed by specialists in secondary health care or are referred to tertiary health care. GI endoscopy is one of the main diagnostic and therapeutic modalities in the management of GI disease. Development of GI endoscopy in Indonesia started before World War II and, today, many GI endoscopy procedures are conducted in Indonesia, both diagnostic and therapeutic. Based on August 2013 data, there are 515 GI endoscopists in Indonesia. Most GI endoscopists are competent in carrying out basic endoscopy procedures, whereas only a few carry out advanced endoscopy procedures, including therapeutic endoscopy. Recently, the GI endoscopy training system in Indonesia consists of basic GI endoscopy training of 3-6 months held at 10 GI endoscopy training centers. GI endoscopy training is also eligible as part of a fellowship program of consultant gastroenterologists held at six accredited fellowship centers in Indonesia. Indonesian Society for Digestive Endoscopy in collaboration with GI endoscopy training centers in Indonesia and overseas has been working to increase quality and number of GI endoscopists, covering both basic and advanced GI endoscopy procedures.
[ES] Definición del término Experiencia remisión de V. ciencia y experiencia. en el diccionario Dicter. [EN] Definition of the word Experiencia remisión de V. ciencia y experiencia. in the dictionary Dicter.
A Mata; J Llach; JM Bordas
Wireless capsule endoscopy is a new technique that allows complete exploration of the small bowel without external wires. Its role has been analyzed in many small bowel diseases such as obscure gastrointestinal bleeding, Crohn's disease and gastrointestinal polyposis syndromes with promising results. Studies on other pathologies (I.e. Small bowel tumour, celiac disease) are under evaluation to define the role of this technique.
Full Text Available The application of robotics in gastrointestinal endoscopy is a much anticipated technological advancement that is attracting an enormous amount of interest from innovators and end-users alike. Emerging robotics-enhanced endoscopy platforms for performance of various endoscopic interventional procedures are already in development and some are expected to be in the pipeline for commercialization in another few years′ time. In particular, the Master And Slave Transluminal Endoscopic Robot (MASTER developed by a collaboration between the National University of Singapore and the Nanyang Technological University, Singapore is already in human trials for an endoluminal procedure, endoscopic submucosal dissection (ESD. The results on trials performed on five patients with early gastric neoplasia have demonstrated the feasibility and safety of using the system for such procedure, while also shortening the procedure time. This article will highlight the advantages of robotics innovations in gastrointestinal endoscopy, with the MASTER as an example, and explore some of the many possibilities for future applications of robotics-enhanced endoscopy.
Magne, M L
Endoscopic examinations provide a valuable, noninvasive adjunct in the diagnosis and staging of many neoplastic disorders (Table 1). Additionally, the clinical applications of endoscopic-guided laser or photodynamic therapy have yet to be investigated thoroughly in companion animals. Endoscopy does not eliminate the need for other diagnostics, rather it should be considered complementary to more "traditional" procedures such as radiography, surgery, and ultrasonography.
Full Text Available Introduction : There is increasing interest in sedation for upper gastrointestinal endoscopy (UGE. Prospective randomized studies comparing sedation properties and complications of propofol and midazolam/meperidine in upper gastrointestinal endoscopy (UGE are few. Aim: To compare propofol and midazolam/meperidine sedation for UGE in terms of cardiopulmonary side effects, patient and endoscopist satisfaction and procedure-related times. Material and methods: This was a prospective, randomized, double-blind study of propofol versus midazolam and meperidine in 100 patients scheduled for diagnostic upper gastrointestinal endoscopy. The patients were divided into propofol and midazolam/meperidine groups. Randomization was generated by a computer. Cardiopulmonary side effects (hypotension, bradycardia, hypoxemia, procedure-related times (endoscopy time, awake time, time to hospital discharge, and patient and endoscopist satisfaction were compared between groups. Results: There was no significant difference between the groups with respect to the cost, endoscopy time, or demographic and clinical characteristics of the patients. Awake time and time to hospital discharge were significantly shorter in the propofol group (6.58 ±4.72 vs. 9.32 ±4.26 min, p = 0.030 and 27.60 ±7.88 vs. 32.00 ±10.54 min, p = 0.019. Hypotension incidence was significantly higher in the propofol group (12% vs. 0%, p = 0.027. The patient and endoscopist satisfaction was better with propofol. Conclusions : Propofol may be preferred to midazolam/meperidine sedation, with a shorter awake and hospital discharge time and better patient and endoscopist satisfaction. However, hypotension risk should be considered with propofol, and careful evaluation is needed, particularly in cardiopulmonary disorders.
Video capsule endoscopy is an attractive and patient- friendly tool that provides high quality images of the small bowel. Obscure gastrointestinal bleeding is the primary and most evaluated indication to capsule endoscopy; however, indications are expanding and a small number of preliminary reports have been presented concerning the role of video capsule endoscopy in the diagnosis of celiac disease. The purpose of this review is to update the current knowledge and to hypothesize on future perspectives of the use of video capsule endoscopy in patients with celiac disease.
Colon and rectum localizations of an disease or a parasitosis depend essentially on the nature of the pathogenous agent and the host resistance. Acute enterocolitis is secondary to enterotoxinogenous germs (such as cholera vibrio), invasive germs (such as shigella), penetrating germs (such as salmonella); viruses are seldom concerned. Parasitic colitis include mostly amibiasis and bilharziosis. Infectious and parasitic enterocolitis may be transmitted sexually. On the other hand, certain venereal diseases have intestinal manifestations. Finally, in AIDS, timely gastro-intestinal infections develop. The diagnosis rests on endoscopy, histological examination and biological and parasitological samplings.
Koelsch, K A
1. Knowledge of the gastroenterological endoscopy and biopsy is necessary at all levels of medical education. 2. Knowledge of students: possible methods, diagnostic effectiveness, stress of the patients. Knowledge of the candidates for specialisation: indications, contraindications, possibilities of the method also in reference to the individual case. Persons interested in the subspecialisation gastro-enterology: theory, possibilities and limits, technical performance. Experienced endoscopists: regular refreshment and supplementation of knowledge and skill in highly specialised endoscopic centres. 3. Tested teaching methods are lecture, report, study of atlants and text-books, demonstrations of diapositives in connection with schematic figures, seminars with diapositives, film demonstrations, work at the patient under supervision of the tutor and use of a demonstration device as well as endoscopic demonstration by means of colour television. The centre is, however, the individual examination of the patient. 4. Knowledge of the subspecialist: History of endoscopy, knowledge of instruments, optics and endoscopic perspective, physical fundaments about light and photography, human macro- and microscopic anatomy, care of instruments and desinfection. Indications, contraindications, possibilities and limits of the method, emergency and intensive medicine, writing of the findings.
Parot, Vicente; Lim, Daryl; González, Germán; Traverso, Giovanni; Nishioka, Norman S.; Vakoc, Benjamin J.
Abstract. While color video endoscopy has enabled wide-field examination of the gastrointestinal tract, it often misses or incorrectly classifies lesions. Many of these missed lesions exhibit characteristic three-dimensional surface topographies. An endoscopic system that adds topographical measurements to conventional color imagery could therefore increase lesion detection and improve classification accuracy. We introduce photometric stereo endoscopy (PSE), a technique which allows high spatial frequency components of surface topography to be acquired simultaneously with conventional two-dimensional color imagery. We implement this technique in an endoscopic form factor and demonstrate that it can acquire the topography of small features with complex geometries and heterogeneous optical properties. PSE imaging of ex vivo human gastrointestinal tissue shows that surface topography measurements enable differentiation of abnormal shapes from surrounding normal tissue. Together, these results confirm that the topographical measurements can be obtained with relatively simple hardware in an endoscopic form factor, and suggest the potential of PSE to improve lesion detection and classification in gastrointestinal imaging. PMID:23864015
Esteve Castelló, Eva; Canedo Ibarra, Sabrina
Los niños pequeños están biológicamente preparados y motivados para aprender acerca del mundo que les rodea por lo que las experiencias personales en el mundo del día a día son la base de su desarrollo. En la infancia, los niños procesan las representaciones de sus experiencias personales en formas complejas creando representaciones generalizadas. Estas representaciones generalizadas de los eventos son la base para la comprensión y su acción en el mundo, les permiten reconocer regularidades, ...
Waschke, Kevin A; Anderson, John; Macintosh, Donald; Valori, Roland M
Endoscopy training has traditionally been accomplished by an informal process in the endoscopy unit that parallels apprenticeship training seen in other areas of professional education. Subsequent to an audit, a series of interventions were implemented in the English National Health Service to support both service delivery and to improve endoscopy training. The resulting training centers deliver a variety of hands-on endoscopy courses, established in parallel with the roll out of a colon cancer screening program that monitors and documents quality outcomes among endoscopists. The program developed a 'training the trainer' module that subsequently became known as the Training the Colonoscopy Trainer course (TCT). Several years after its implementation, colonoscopy quality outcomes in the UK have improved substantially. The core TCT program has spread to other countries with demonstration of a marked impact on endoscopy training and performance. The aim of this chapter is to describe the principles that underlie effective endoscopy training in this program using the TCT as an example. While the review focuses on the specific example of colonoscopy training, the approach is generic to the teaching of any technical skill; it has been successfully transferred to the teaching of laparoscopic surgery as well as other endoscopic techniques.
Luján Mora, Sergio
Presentación de la conferencia "Experiencias en desarrollos tecnológicos accesibles: Experiencia Ecuador" impartida en la III Jornada de Accesibilidad Digital 2016 (http://tecdigital.tec.ac.cr/servicios/accesibilidad3/) celebrada del 25 al 28 de octubre de 2016 y organizada por el Instituto Tecnológico de Costa Rica (TEC).
Spada, C; Hassan, C; Galmiche, J P; Neuhaus, H; Dumonceau, J M; Adler, S; Epstein, O; Gay, G; Pennazio, M; Rex, D K; Benamouzig, R; de Franchis, R; Delvaux, M; Devière, J; Eliakim, R; Fraser, C; Hagenmuller, F; Herrerias, J M; Keuchel, M; Macrae, F; Munoz-Navas, M; Ponchon, T; Quintero, E; Riccioni, M E; Rondonotti, E; Marmo, R; Sung, J J; Tajiri, H; Toth, E; Triantafyllou, K; Van Gossum, A; Costamagna, G
PillCam colon capsule endoscopy (CCE) is an innovative noninvasive, and painless ingestible capsule technique that allows exploration of the colon without the need for sedation and gas insufflation. Although it is already available in European and other countries, the clinical indications for CCE as well as the reporting and work-up of detected findings have not yet been standardized. The aim of this evidence-based and consensus-based guideline, commissioned by the European Society of Gastrointestinal Endoscopy (ESGE) is to furnish healthcare providers with a comprehensive framework for potential implementation of this technique in a clinical setting.
Professor Adil Ibrahimi
Full Text Available Interventional endoscopy has evolved in parallel with diagnostic endoscopy and throughout the years, the performance of interventional endoscopy has proved to be efficient in improving morbidity and mortality in many diseases: biliopancreatic catheterism, dilatations of most stenosis in different parts of the digestive tube, haemostatic treatment, prosthetic fitting and installation, as well as benign and malignant tumors removal (polypectomy, mucosectomy....
Monalisa Filip; Sevasti(t)a Iordache; Adrian S(a)ftoiu; Tudorel Ciurea
It is well known that angiogenesis is critical in the transition from premalignant to malignant lesions.Consequently,early detection and diagnosis based on morphological changes to the microvessels are crucial.In the last few years,new imaging techniques which utilize the properties of light-tissue interaction have been developed to increase early diagnosis of gastrointestinal (GI)tract neoplasia.We analyzed several "red-flag" endoscopic techniques used to enhance visualization of the vascular pattern of preneoplastic and neoplastic lesions (e.g.trimodal imaging including autofluorescence imaging,magnifying endoscopy and narrow band imaging).These new endoscopic techniques provide better visualization of mucosal microsurface structure and microvascular architecture and may enhance the diagnosis and characterization of mucosal lesions in the GI tract.In the near future,it is expected that trimodal imaging endoscopy will be practiced as a standard endoscopy technique as it is quick,safe and accurate for making a precise diagnosis of gastrointestinal pathology,with an emphasis on the diagnosis of early GI tract cancers.Further large-scale randomized controlled trials comparing these modalities in different patient subpopulations are warranted before their endorsement in the routine practice of GI endoscopy.
Full Text Available Gastrointestinal endoscopy is a safe, efficient technique with minimal complications, and a useful diagnostic tool for the pediatric population. Under ideal conditions endoscopies for children should be performed by experienced pediatric endoscopists. In this study we report our experience with pediatric endoscopy at the general adult endoscopy unit in our hospital. Our goal is to quantify the number of endoscopies performed in children, as well as their indications and findings, the type of sedation or anesthesia used, and the time waiting for the test to occur. Our experience demonstrates that endoscopists in a general adult gastroenterology department, working together with pediatricians, may perform a relevant number of endoscopies in children in a fast, safe, effective manner.La endoscopia gastrointestinal es una técnica segura y eficiente con mínimas complicaciones, así como una útil herramienta diagnóstica en la población pediátrica. En condiciones ideales, las endoscopias en niños deberían ser realizadas por endoscopistas pediátricos experimentados. En este estudio reportamos nuestra experiencia en la realización de endoscopias pediátricas en la Unidad de Endoscopias general de adultos de nuestro hospital. El objetivo es cuantificar la cantidad de endoscopias realizadas en niños, así como las indicaciones y hallazgos de las mismas, el tipo de sedación o anestesia empleado y el tiempo de espera para la realización de la prueba. Nuestra experiencia demuestra que los endoscopistas de un servicio de gastroenterología general de adultos, en colaboración con pediatras, pueden realizar un número importante de endoscopias a niños, de forma rápida, segura y eficaz.
Morales, Mario P; Mancini, Gregory J; Miedema, Brent W; Rangnekar, Nitin J; Koivunen, Debra G; Ramshaw, Bruce J; Eubanks, W Stephen; Stephenson, Hugh E
New advances in endoscopic surgery make it imperative that future gastrointestinal surgeons obtain adequate endoscopy skills. An evaluation of the 2001-02 general surgery residency endoscopy experience at the University of Missouri revealed that chief residents were graduating with an average of 43 endoscopic cases. This met American Board of Surgery (ABS) and Accreditation Council for Graduate Medical Education (ACGME) requirements but is inadequate preparation for carrying out advanced endoscopic surgery. Our aim was to determine if endoscopy volume could be improved by dedicating specific staff surgeon time to a gastrointestinal diagnostic center at an affiliated Veterans Administration Hospital. During the academic years 2002-05, two general surgeons who routinely perform endoscopy staffed the gastrointestinal endoscopy center at the Harry S. Truman Hospital two days per week. A minimum of one categorical surgical resident participated during these endoscopy training days while on the Veterans Hospital surgical service. A retrospective observational review of ACGME surgery resident case logs from 2001 to 2005 was conducted to document the changes in resident endoscopy experience. The cases were compiled by postgraduate year (PGY). Resident endoscopy case volume increased 850% from 2001 to 2005. Graduating residents completed an average of 161 endoscopies. Endoscopic experience was attained at all levels of training: 26, 21, 34, 23, and 26 mean endoscopies/year for PGY-1 to PGY-5, respectively. Having specific endoscopy training days at a VA Hospital under the guidance of a dedicated staff surgeon is a successful method to improve surgical resident endoscopy case volume. An integrated endoscopy training curriculum results in early skills acquisition, continued proficiency throughout residency, and is an efficient way to obtain endoscopic skills. In addition, the foundation of flexible endoscopic skill and experience has allowed early integration of surgery
Waterman, Matti; Gralnek, Ian M
Video capsule endoscopy has acquired wide clinical acceptance since its the US Food and Drug Administration approval in 2001. Recently, the technology of video capsule endoscopy has been adapted to other organs in the gastrointestinal tract, including the esophagus and colon. In this review, we discuss esophageal capsule endoscopy (ECE)-the procedure, its indications, contraindications, safety, and future applications. ECE is a minimally invasive procedure that uses special video capsules with ability to acquire images from 2 cameras with high image storing speed of 14 to 18 frames per second. A special ingestion procedure allows for prolonged esophageal transit time and an optimized view of the gastroesophageal junction. ECE has been shown to have moderately high sensitivity and accuracy in the diagnosis and surveillance of Barrett esophagus in patients with gastroesophageal reflux disease but has not demonstrated superiority to esogastroduodenoscopy in cost-effectiveness models. In patients with portal hypertension, ECE has a sensitivity of 63% to 100% for screening of esophageal varices, but does not seem to be superior to esogastroduodenoscopy in its cost-effectiveness. No serious complications have been reported after ECE although a low rate of esophageal capsule retention (0.7% to 2.2%) has been reported, usually because of unsuspected esophageal strictures. Contraindications to capsule endoscopy include known or suspected gastrointestinal and esophageal obstruction, strictures, or fistulas, intestinal pseudoobstruction, and children under 10 years of age. It is expected that improvements in imaging technology will improve the accuracy of ECE with the development of immunological-based and chemical-based diagnostic capabilities.
Charakorn, Natamon; Kezirian, Eric J
Drug-induced sleep endoscopy (DISE) is an upper airway evaluation technique in which fiberoptic examination is performed under conditions of unconscious sedation. Unique information obtained from this 3-dimensional examination of the airway potentially provides additive benefits to other evaluation methods to guide treatment selection. This article presents recommendations regarding DISE technique and the VOTE Classification system for reporting DISE findings and reviews the evidence concerning DISE test characteristics and the association between DISE findings and treatment outcomes.
Montanari, F; Viola, L; Amarri, S
Sedation for children doing diagnostic or operative pediatric gastrointestinal endoscopy (PE) procedures is performed differently over the world and no consensus is yet agreed on the best paediatric endoscopy sedation (PES). Some centres do not use any sedation, especially in infants, most centre use some form of sedation: conscious sedation, deep sedation and general anaesthesia. We review sedation drugs and describe our centre protocol on 188 consecutive PE: oral premedication with flunitrazepam (0.05 mg/kg/dose) at least 30 min before procedure, petidine (1 mg/kg) followed by increasing boluses of midazolam (0.05 mg/kg up to a maximal 0.2 mg/kg or 5 mg) were given i.v. to obtain a conscious sedation. All PE could be performed and ended safely, PES resulted satisfactory in approximately 65% of patient having conscious sedation. SaO2 Endoscopy and sedation was always performed by the PE team in the immediate vicinity of anaesthesiologists at work. PE can be safely performed with conscious sedation. Basic and advanced resuscitation skills are needed for the PE team who wish to perform both endoscopic and sedation procedures.
Full Text Available Este artículo parte de la comprensión de populismos como forma de gobierno y/o liderazgo político, como estrategia de ejercicio de poder y/o de llegada al poder, compatible con múltiples discursos ideológicos. Su clave es la relación directa entre el líder (gobernante o pretendiente a gobernante con los gobernados (o potenciales gobernados por encima de los grupos intermedios (“clase política”, sistema partidista de representación, movimientos ideológicos y culturales, etc.. De ahí, se postula que el movimiento de los “narodniki” en Rusia del siglo XIX, nombrado en muchos textos como iniciador del populismo, no tenía el carácter populista. En cambio, múltiples experiencias populistas en la historia de Rusia, desde Iván el Terrible hasta Vladimir Putin se sitúan en el cruce de la relación entre el gobernante, los sectores intermedios y los gobernados
Kim, Ki Bae; Yoon, Soon Man; Youn, Sei Jin
Endoscopy for acute nonvariceal upper gastrointestinal bleeding plays an important role in primary diagnosis and management, particularly with respect to identification of high-risk stigmata lesions...
... Upper Endoscopy for Kids (North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition) - PDF Also in Spanish Women Hysteroscopy (American College of Obstetricians and Gynecologists) - ...
Rees, Colin J; Ngu, Wee Sing; Regula, Jaroslaw
Background and study aim: Gastrointestinal endoscopy is a rapidly evolving research field. The European Society of Gastrointestinal Endoscopy (ESGE) plays a key role in shaping opinion and endoscopy activity throughout Europe and further afield. Establishing key unanswered questions within the fi...
Dardour, J C; Abbou, R
For many years, the face-lift has not been the only intervention for facial rejuvenation. It is necessary today to specify the type of face-lift, cervico-facial lifting, frontal lifting or facelift. We will consider in this article the frontal lift and centro-facial lift and its possible execution assisted by endoscopy with therefore minimal scars, hidden in the scalp. We will consider successively its technique, its indications and its results highlighting a very long hold over time. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Osman Ersoy; Bulent Sivri; Yusuf Bayraktar
Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.
C.W. Teshima (Christopher)
textabstractAdvances in gastrointestinal (GI) endoscopy have played an important role in improving the diagnostic and therapeutic options for physicians treating patients with GI diseases. Indeed, the advent of endoscopy transformed the field of Gastroenterology and contributed significantly to its
Sumario: L La experiencia cristiana como experiencia de unidad - 1. Qué entender por experiencia cristiana - 2. La experiencia cristiana como experiencia de fe - 3. La experiencia cristiana como experiencia espiritual - 4. La experiencia cristiana como experiencia de unidad - II. Creatividad teologica: pensar teologicamente desde la experiencia de unidad - 1. Una teología agotada: el pensar teológico bajo el «síndrome de la razón ilutrada» - 2, La decadencia cultural como desafío ...
M.A. Pérez Fernández
Full Text Available Décadas de uso inadecuado de los recursos naturales en Australia han llevado a la extinción de numerosas especies autóctonas. Aprendiendo de sus propios errores, se han inicido recientemente diferentes proyectos de conservación en los que participan diversos agentes interesados. La Región de los Central Ranges, en el Desierto de Gibson, pertenece al pueblo aborigen Ngaanyatjarra. En los años 90 se llevó a cabo una campaña de recolección de organismos, patrocinada por el Museo de Western Australia y el Departamento de Conservación Ambiental (DEC, en la que participaron miembros de la comunidad Ngaanyatjarra, conocedores y cuidadores del territorio. El resultado científico se tradujo en la identificación de dos nuevas especies, así como numerosas nuevas citas de plantas y animales para el territorio. La minería es una de las actividades más impactantes en Australia, pero la concienciación social ha llevado a que las compañías desarrollen importantes campañas de protección de especies. El mulgara (Dasycercus cristicaula ocupaba zonas que hoy en día se dedican a la minería, y de las que prácticamente ha desaparecido. Un programa de investigación financiado por la empresa Resolute Resources y dirigido por el Departamento de Conservación y Manejo del Territorio (CALM ha permitido identificar poblaciones de este marsupial carnívoro y diseñar un programa de manejo cuyo objetivo es evitar actuaciones incompatibles con su actividad biológica. El resultado más relevante en ambas iniciativas ha sido la colaboración entre diferentes agentes implicados, con intercambio de conocimientos y experiencias. Especialmente importante ha sido la posibilidad de diseñar planes de manejo y actuación sobre el territorio, orientados a la preservación de valores naturales y culturales antiguos.
Messmann, H; Endlicher, E; Gelbmann, C M; Schölmerich, J
Fluorescence endoscopy is a new technique which allows a better detection of non-visible malignant or premalignant lesions or, those which are difficult to detect. Exogenously applied sensitisers accumulate selectively in malignant lesions and induce fluorescence after illumination with light of adequate wavelength. However, also endogenous fluorophores, different located in malignant or benign lesions, induce a different autofluorescence in these lesions. Tissue fluorescence can be detected by optical sampling of the mucosa using fluorescence spectroscopy or by generating real time fluorescence images with specialised camera systems. Compared to point fluorescence spectroscopy the latter technique enables the screening of large surface areas of mucosa. Meanwhile, fluorescence endoscopy is a widely used technique in urology employing 5-aminolaevulinic acid sensitisation. In gastroenterology, this technique seems promising for the detection of early cancers or dysplasia in patients with Barrett's oesophagus or ulcerative colitis. Using different sensitisers, photodynamic therapy seems to be a promising option for patients with advanced oesophageal cancer and in the palliative treatment of non-resectable bile duct cancer, furthermore for patients with early gastric cancer and dysplasia in Barrett's oesophagus. Probably, by laser light fractionation or a combination of different sensitisers, an enhanced effect can be expected.
Full Text Available The increasing demand for non-invasive (or less-invasive monitoring and treatment of medical conditions has attracted both physicians and engineers to work together and investigate new methodologies. Wireless capsule endoscopy is a successful example of such techniques which has become an accepted routine for diagnostic inspection of the gastrointestinal tract. This method offers a non-invasive alternative to traditional endoscopy and provides the opportunity for exploring distal areas of the small intestine which are otherwise not accessible. Despite these advantages, wireless capsule endoscopy is still limited in functionality compared to traditional endoscopy. Wireless capsule endoscopes with advanced functionalities, such as biopsy or drug delivery, are highly desirable. In this article, the current status of wireless capsule endoscopy is reviewed together with some of its possible therapeutic applications as well as the existing challenges.
Full Text Available Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA. The objective of this study was to describe Anesthesia related complications in children undergoing elective GI endoscopy. Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data , location of GI endoscopy , perioperative vital singe , recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest. 8 patients (0.5% have transient bradicardia in post operative care Unit. 83 patients (5.9% have post operative nausea and vomiting controlled by medication. 6 patients (0.4% have post operative agitation controlled by medication. Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.
Sedation allows patients to tolerate unpleasant endoscopic procedures by relieving anxiety, discomfort, or pain. It also reduces a patient's risk of physical injury during endoscopic procedures, while providing the endoscopist with an adequate setting for a detailed examination. Sedation is therefore considered by many endoscopists to be an essential component of gastrointestinal endoscopy. Endoscopic sedation by nonanesthesiologists is a worldwide practice and has been proven effective and safe. Moderate sedation/analgesia is generally accepted as an appropriate target for sedation by nonanesthesiologists. This focused review describes the general principles of endoscopic sedation, the detailed pharmacology of sedatives and analgesics (focused on midazolam, propofol, meperidine, and fentanyl), and the multiple regimens available for use in actual practice.
Full Text Available Abstract Background Breast ductal endoscopy is a relatively new diagnostic method with ever growing importance in the work-up of patients with bloody nipple discharge. The ability to perform ductal endoscopy is very important and useful for breast fellows. Learning curve in breast ductal endoscopy remains a terra incognita, since no systematic studies have addressed this topic. The purpose of this study is to determine the point (number of procedures during training beyond which ductal endoscopy is successfully performed. Findings Ten breast fellows received training in our Breast Unit. For the training process, an ex vivo model was adopted. Fellows were trained on 20 surgical specimens derived from modified radical mastectomy for breast cancer. The target of the education program was to acquire proficiency in performing ductoscopy. The achievement of four consecutively successful ductal endoscopies was determined as the point beyond which proficiency had been achieved. The number of procedures needed for the achievement of proficiency as defined above ranged between 9 and 17 procedures. The median value was 13 procedures; i.e. 50% of trainees had achieved proficiency at the 13th procedure or earlier. Conclusion These pilot findings point to approximately 13 procedures as a point beyond which ductal endoscopy is successfully performed; studies on a larger number of fellows are nevertheless needed. Further research, focusing on the learning curves of different training models of ductal endoscopy, seems desirable.
Zagouri, Flora; Sergentanis, Theodoros N; Giannakopoulou, Georgia; Panopoulou, Effrosyni; Chrysikos, Dimosthenis; Bletsa, Garifallia; Flessas, John; Filippakis, George; Papalabros, Alexandros; Bramis, Kostas J; Zografos, George C
Background Breast ductal endoscopy is a relatively new diagnostic method with ever growing importance in the work-up of patients with bloody nipple discharge. The ability to perform ductal endoscopy is very important and useful for breast fellows. Learning curve in breast ductal endoscopy remains a terra incognita, since no systematic studies have addressed this topic. The purpose of this study is to determine the point (number of procedures during training) beyond which ductal endoscopy is successfully performed. Findings Ten breast fellows received training in our Breast Unit. For the training process, an ex vivo model was adopted. Fellows were trained on 20 surgical specimens derived from modified radical mastectomy for breast cancer. The target of the education program was to acquire proficiency in performing ductoscopy. The achievement of four consecutively successful ductal endoscopies was determined as the point beyond which proficiency had been achieved. The number of procedures needed for the achievement of proficiency as defined above ranged between 9 and 17 procedures. The median value was 13 procedures; i.e. 50% of trainees had achieved proficiency at the 13th procedure or earlier. Conclusion These pilot findings point to approximately 13 procedures as a point beyond which ductal endoscopy is successfully performed; studies on a larger number of fellows are nevertheless needed. Further research, focusing on the learning curves of different training models of ductal endoscopy, seems desirable. PMID:19566939
Valori, Roland M; Johnston, Deborah J
A modern endoscopy service delivers high volume procedures that can be daunting, embarrassing and uncomfortable for patients . Endoscopy is hugely beneficial to patients but only if it is performed to high standards . Some consequences of poor quality endoscopy include worse outcomes for cancer and gastrointestinal bleeding, unnecessary repeat procedures, needless damage to patients and even avoidable death . New endoscopy technology and more rigorous decontamination procedures have made endoscopy more effective and safer, but they have placed additional demands on the service. Ever-scarcer resources require more efficient, higher turnover of patients, which can be at odds with a good patient experience, and with quality and safety. It is clear from the demands put upon it, that to deliver a modern endoscopy service requires effective leadership and team working . This chapter explores what constitutes effective leadership and what makes great clinical teams. It makes the point that endoscopy services are not usually isolated, independent units, and as such are dependent for success on the organisations they sit within. It will explain how endoscopy services are affected by the wider policy and governance context. Finally, within the context of the collection of papers in this edition of Best Practice & Research: Clinical Gastroenterology, it explores the potentially conflicting relationship between training of endoscopists and service delivery. The effectiveness of leadership and teams is rarely the subject of classic experimental designs such as randomized controlled trials. Nevertheless there is a substantial literature on this subject within and particularly outside healthcare . The authors draw on this wider, more diffuse literature and on their experience of delivering a Team Leadership Programme (TLP) to the leaders of 70 endoscopy teams during the period 2008-2012. (Team Leadership Programme Link-http://www.qsfh.co.uk/Page.aspx?PageId=Public).
Cristina Carretero; Ignacio Fernandez-Urien; Maite Betes; Miguel Mu(n)oz-Navas
Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of an unknown origin that persists or recurs after negative initial upper and lower endoscopies.Several techniques,such as endoscopy,arteriography,scintigraphy and barium radiology are helpful for recognizing the bleeding source;nevertheless,in about 5%-10% of cases the bleeding lesion cannot be determined.The development of videocapsule endoscopy (VCE) has permitted a direct visualization of the small intestine mucosa.We will analyze those techniques in more detail.The diagnostic yield of CE for OGIB varies from 38% to 93%,being in the higher range in those cases with obscure-overt bleeding.
Kim, Ki Bae; Yoon, Soon Man; Youn, Sei Jin
Endoscopy for acute nonvariceal upper gastrointestinal bleeding plays an important role in primary diagnosis and management, particularly with respect to identification of high-risk stigmata lesions and to providing endoscopic hemostasis to reduce the risk of rebleeding and mortality. Early endoscopy, defined as endoscopy within the first 24 hours after presentation, improves patient outcome and reduces the length of hospitalization when compared with delayed endoscopy. Various endoscopic hemostatic methods are available, including injection therapy, mechanical therapy, and thermal coagulation. Either single treatment with mechanical or thermal therapy or a treatment that combines more than one type of therapy are effective and safe for peptic ulcer bleeding. Newly developed methods, such as Hemospray powder and over-the-scope clips, may provide additional options. Appropriate decisions and specific treatment are needed depending upon the conditions.
Capsule Endoscopy: New Technology, Old Complication. ... A 65-year-old female with a long standing history of anemia and obscure gastrointestinal ... The patient was resuscitated and taken up for an explorative laparotomy where a short ...
Ayman E. Eskander
CONCLUSION: Ketamine sedation found to be safe for paediatric gastrointestinal endoscopy in Egyptian children without co-morbidities. Transient Hypoxia (13% may occur but easily reversed by nasal oxygen therapy.
Borgaonkar, Mark R; Lawrence Hookey; Roger Hollingworth; Kuipers, Ernst J; Alan Forster; David Armstrong; Alan Barkun; Ronald Bridges; Rose Carter; Chris de Gara; Catherine Dube; Robert Enns; Donald MacIntosh; Sylviane Forget; Grigorios Leontiadis
The growth in the use of endoscopy to diagnose and treat many gastointestinal disorders, and its central role in cancer screening programs, has led to a significant increase in the number of procedures performed. This growth, however, has also led to many variations in, among others, the provision of services, the choice of sedative medications and the training of providers. The recognition of the significance of quality in endoscopy has prompted several countries, including Canada, to initia...
Full Text Available Colon capsule endoscopy utilizing PillCam COLON 2 capsule allows for visualization potentially of the entire colon and is currently approved for patients who cannot withstand the rigors of traditional optical colonoscopy (OC and associated sedation as well as those that had an OC that was incomplete for technical reasons other than a poor preparation. We will then describe the prior experience and current status of colon capsule endoscopy.
We outline probable and possible developments with wireless capsule endoscopy. It seems likely that capsule endoscopy will become increasingly effective in diagnostic gastrointestinal endoscopy. This will be attractive to patients especially for cancer or varices detection because capsule endoscopy is painless and is likely to have a higher take up rate compared to conventional colonoscopy and gastroscopy. Double imager capsules with increased frame rates have been used to image the esophagus for Barrett's and esophageal varices. The image quality is not bad but needs to be improved if it is to become a realistic substitute for flexible upper and lower gastrointestinal endoscopy. An increase in the frame rate, angle of view, depth of field, image numbers, duration of the procedure and improvements in illumination seem likely. Colonic, esophageal and gastric capsules will improve in quality, eroding the supremacy of flexible endoscopy, and become embedded into screening programs. Therapeutic capsules will emerge with brushing, cytology, fluid aspiration, biopsy and drug delivery capabilities. Electrocautery may also become possible. Diagnostic capsules will integrate physiological measurements with imaging and optical biopsy, and immunologic cancer recognition. Remote control movement will improve with the use of magnets and/or electrostimulation and perhaps electromechanical methods. External wireless commands will influence capsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However, it should be noted that speculations about the future of technology in any detail are almost always wrong.
Yoon, Tae-Jong; Cho, Young-Seok
Imaging based on photoacoustic effect relies on illuminating with short light pulses absorbed by tissue absorbers, resulting in thermoelastic expansion, giving rise to ultrasonic waves. The ultrasonic waves are then detected by detectors placed around the sample. Photoacoustic endoscopy (PAE) is one of four major implementations of photoacoustic tomography that have been developed recently. The prototype PAE was based on scanning mirror system that deflected both the light and the ultrasound. A recently developed mini-probe was further miniaturized, and enabled simultaneous photoacoustic and ultrasound imaging. This PAE-endoscopic ultrasound (EUS) system can offer high-resolution vasculature information in the gastrointestinal (GI) tract and display differences between optical and mechanical contrast compared with single-mode EUS. However, PAE for endoscopic GI imaging is still at the preclinical stage. In this commentary, we describe the technological improvements in PAE for possible clinical application in endoscopic GI imaging. In addition, we discuss the technical details of the ultrasonic transducer incorporated into the photoacoustic endoscopic probe.
Marco Pennazio; Emanuele Rondonotti; Roberto de Franchis
Until recently,diagnosis and management of small-bowel tumors were delayed by the difficulty of access to the small bowel and the poor diagnostic capabilities of the available diagnostic techniques.An array of new methods has recently been developed,increasing the possibility of detecting these tumors at an earlier stage.Capsule endoscopy (CE) appears to be an ideal tool to recognize the presence of neoplastic lesions along this organ,since it is non-invasive and enables the entire small bowel to be visualized.Highquality images of the small-bowel mucosa may be captured and small and fiat lesions recognized,without exposure to radiation.Recent studies on a large population of patients undergoing CE have reported small-bowel tumor frequency only slightly above that reported in previous surgical series (range,1.6%-2.4%)and have also confirmed that the main clinical indication to CE in patients with small-bowel tumors is obscure gastrointestinal (GI) bleeding.The majority of tumors identified by CE are malignant;many were unsuspected and not found by other methods.However,it remains difficult to identify pathology and tumor type based on the lesion's endoscopic appearance.Despite its limitations,CE provides crucial information leading in most cases to changes in subsequent patient management.Whether the use of CE in combination with other new diagnostic (MRI or multidetector CT enterography) and therapeutic (Push-and-pull enteroscopy) techniques will lead to earlier diagnosis and treatment of these neoplasms,ultimately resulting in a survival advantage and in cost savings,remains to be determined through carefully-designed studies.
Domínguez C,Claudio; Zamora F,Jessica; Barrera P,Sandra; Tacla F,Ximena
Objetivo: Presentar la experiencia inicial en el diagnóstico histológico con biopsia endometrial ambulatoria obtenida con pipelle de Cornier. Material y método: Se efectuó biopsia endometrial ambulatoria con pipelle de Cornier en 144 pacientes con sospecha clínica y/o ecográfica de patología endometrial difusa. Resultados: Se logró realizar el procedimiento a 131 pacientes (91%), obteniéndose diagnóstico histológico satisfactorio en 110 casos (76,4%). De las 110 muestras analizadas, se diagno...
Obara, Katsutoshi; Haruma, Ken; Irisawa, Atsushi; Kaise, Mitsuru; Gotoda, Takuji; Sugiyama, Masanori; Tanabe, Satoshi; Horiuchi, Akira; Fujita, Naotaka; Ozaki, Makoto; Yoshida, Masahiro; Matsui, Toshiyuki; Ichinose, Masao; Kaminishi, Michio
Recently, the need for sedation in gastrointestinal endoscopy has been increasing. However, the National Health Insurance Drug Price list in Japan does not include any drug specifically used for the sedation. Although benzodiazepines are the main medication, their use in cases of gastrointestinal endoscopy has not been approved. This has led the Japan Gastrointestinal Endoscopy Society to develop the first set of guidelines for sedation in gastrointestinal endoscopy on the basis of evidence-based medicine in collaboration with the Japanese Society for Anesthesiologists. The present guidelines comprise 14 statements, five of which were judged to be valid on the highest evidence level and three on the second highest level. The guidelines are not intended to strongly recommend the use of sedation for gastrointestinal endoscopy, but rather to indicate the policy as to the choice of appropriate procedures when such sedation is deemed necessary. In clinical practice, the final decision as to the use of sedation should be made by physicians considering patient willingness and physical condition.
Durr, Nicholas J.; González, Germán.; Lim, Daryl; Traverso, Giovanni; Nishioka, Norman S.; Vakoc, Benjamin J.; Parot, Vicente
Photometric stereo endoscopy is a technique that captures information about the high-spatial-frequency topography of the field of view simultaneously with a conventional color image. Here we describe a system that will enable photometric stereo endoscopy to be clinically evaluated in the large intestine of human patients. The clinical photometric stereo endoscopy system consists of a commercial gastroscope, a commercial video processor, an image capturing and processing unit, custom synchronization electronics, white light LEDs, a set of four fibers with diffusing tips, and an alignment cap. The custom pieces that come into contact with the patient are composed of biocompatible materials that can be sterilized before use. The components can then be assembled in the endoscopy suite before use. The resulting endoscope has the same outer diameter as a conventional colonoscope (14 mm), plugs into a commercial video processor, captures topography and color images at 15 Hz, and displays the conventional color image to the gastroenterologist in real-time. We show that this system can capture a color and topographical video in a tubular colon phantom, demonstrating robustness to complex geometries and motion. The reported system is suitable for in vivo evaluation of photometric stereo endoscopy in the human large intestine.
Full Text Available Gastrointestinal bleeding that originates in the small intestine is often difficult to diagnose. When successful diagnosis reveals a lesion that can be localized preoperatively, the laparoscopic approach is an appropriate and beneficial treatment modality for small bowel resection. A 69-year-old man presented with a 6-month history of gastrointestinal bleeding and symptomatic transfusion-dependent anemia. Upper and lower endoscopy were normal. Double-balloon endoscopy established the source of the bleeding as a 0.5-cm polypoid mass appearing as a submucosal tumor with redness and pulsation in the lower ileum, suggesting a vascular lesion. Laparoscopic small bowel resection was successful in removing the mass in the ileum. Histological evaluation of the mass revealed an arteriovenous malformation. Preoperative small bowel endoscopy can be useful for diagnosing the cause and localization of arteriovenous malformation in the small intestine.
Vicente Pons Beltrán; Cristina Carretero; Bego(n)a Gonzalez-Suárez; I(n)aqui Fernández-Urien; Miguel Mu(n)oz Navas
In order to have an adequate view of the whole small intestine during capsule endoscopy,the preparation recommended consists of a clear liquid diet and an overnight fast.However,visualization of the small bowel during video capsule endoscopy can be impaired by intestinal contents.To improve mucosal visualization,some authors have evaluated different regimens of preparation.There is no consensus about the necessity of intestinal preparation for capsule endoscopy and it should be interesting to develop adequate guidelines to improve its efficacy and tolerability.Moreover,the effect of preparation type (purgative) on intestinal transit time is not clear.Since a bowel preparation cannot definitively improve its visibility (and theoretically the yield of the test),it is not routinely recommended.
Ashish Kumar Jha
Full Text Available Nanotechnology is the understanding, control of matter and development of engineered devices in nanometer range (1-100 nm. Nanoparticles have different physicochemical properties (small size, large surface area to volume ratio, and high reactivity in comparison to bulk materials of the same composition. The nanotechnology has proved its usefulness in early diagnosis, proteonomics, imaging diagnostics and multifunctional therapeutics. Recent studies have shown its role in early diagnosis and targeted therapy of various gastrointestinal disorders such as hepatitis B virus and hepatitis C virus related liver disease, inflammatory bowel disease, gastric ulcer, and malignancy. Application of this technology appears promising in diagnostic and therapeutic endoscopy such as the endoscopic hemostasis of peptic ulcer bleeding, prevention of clogging of plastic stent and advance capsule endoscopy. This article will highlight the basic concepts of nanotechnology and its potential application in gastrointestinal endoscopy.
Bretthauer, Michael; Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D
To develop standards for high quality in gastrointestinal (GI) endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all GI endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on the requirements for high-quality endoscopy reporting systems in GI endoscopy. Recommendations 1 Endoscopy reporting systems must be electronic. 2 Endoscopy reporting systems should be integrated into hospitals' patient record systems. 3 Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources. 4 Endoscopy reporting systems shall restrict the use of free-text entry to a minimum, and be based mainly on structured data entry. 5 Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated. 6 Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically. 7 Endoscopy reporting systems shall facilitate the inclusion of information on histopathology of detected lesions, patient satisfaction, adverse events, and surveillance recommendations. 8 Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format. 9 Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees. 10 Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.
Tetzlaff, John E; Maurer, Walter G
The role of the anesthesia service in sedation for gastrointestinal endoscopy (GIE) has been steadily increasing. The goals of preprocedural assessment are determined by the specific details of the procedure, the issues related to the illness that requires the endoscopy, comorbidities, the goals for sedation, and the risk of complications from the sedation and the endoscopic procedure. Rather than consider these issues as separate entities, they should be considered as part of a continuum of preparation for GIE. This is told from the perspective of an anesthesiologist who regularly participates in the full range of sedation for GIE.
Kim, Eun Jeong; Lee, Jun; Lee, Ji Woon; Lee, Jun Hyung; Park, Chol Jin; Kim, Young Dae; Lee, Hyun Jin
Peripheral facial nerve palsy (FNP) is a mononeuropathy that affects the peripheral part of the facial nerve. Primary causes of peripheral FNP remain largely unknown, but detectable causes include systemic infections (viral and others), trauma, ischemia, tumor, and extrinsic compression. Peripheral FNP in relation to extrinsic compression has rarely been described in case reports. Here, we report a case of a 71-year-old man who was diagnosed with peripheral FNP following endoscopic submucosal dissection. This case is the first report of the development of peripheral FNP in a patient undergoing therapeutic endoscopy. We emphasize the fact that physicians should be attentive to the development of peripheral FNP following therapeutic endoscopy.
Kiesslich, Ralf; Goetz, Martin; Hoffman, Arthur; Galle, Peter Robert
Gastrointestinal endoscopy is undergoing major improvements, which are driven by new available technologies and substantial refinements of optical features. In this Review, we summarize available and evolving imaging technologies that could influence the clinical algorithm of endoscopic diagnosis. Detection, characterization and confirmation are essential steps required for proper endoscopic diagnosis. Optical and nonoptical methods can help to improve each step; these improvements are likely to increase the detection rate of neoplasias and reduce unnecessary endoscopic treatments. Furthermore, functional and molecular imaging are emerging as new diagnostic tools that could provide an opportunity for personalized medicine, in which endoscopy will define disease outcome or predict the response to targeted therapy.
R Gupta; Nageshwar Duvvuru Reddy
Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy.Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI)bleed.
Harewood, G C
With the growing demand on endoscopy services, optimising practice efficiency has assumed increasing importance. Prior research has identified practice changes, which increase the efficiency in endoscopy. In this study, the potential impact of these practice changes on the current and projected future endoscopy waiting times at our institution was assessed.
Luis Hernández Ibañez
Full Text Available En este artículo se describen las experiencias de los autores en el diseño y la ejecución de tres instalaciones interactivas para museos basados en el concepto de interfaces naturales, es decir, aquellos que hacen uso de los medios de comunicación utilizados por los seres humanos en su relación natural con su entorno a través de capacidades comunes tales como hablar, gesticular, caminar o tocar. Estas instalaciones son parte de la exposición permanente Galicia Dixital, en Santiago de Compostela, que se dedica a ilustrar sobre la cultura de esta región española al tiempo que introduce al visitante en las aplicaciones de las nuevas tecnologías
Vaca Uribe, Dr. Jorge; Universidad Veracruzana
Ni la Secretaria de Educación Pública ni la dirigente sindical del SNTE tienen derecho a embarcar al país en una costosísima Reforma Integral de la Educación Básica (que ya está en marcha aunque poca información pública se dé) sin tomar en cuenta la experiencia acumulada por la propia SEP, por los maestros que sí trabajan y están preocupados por cumplir lo mejor posible con su labor, por los centros de investigación educativa, por las costosas (y a veces reiterativas) evaluaciones que han sid...
Predrag Pesko; Djordjije Saranovic; Vera Todorovic; Milos Bjelovic; Predrag Sabljak; Dejan Stojakov; Ebrahimi Keramatollah; Dejan Velickovic; Bratislav Spica; Branka Nenadic; Aleksandra Djuric-Stefanovic
AIM: To demonstrate the necessity of intraoperative endoscopy in the diagnosis of secondary primary tumors of the upper digestive tract in patients with obstructive hypopharyngeal carcinoma.METHODS: Thirty-one patients with hypopharyngeal squamous cell carcinoma had been operated, with radical intent, at our Institution in the period between 1978 and 2004. Due to obstructive tumor mass, in 7(22.6%) patients, preoperative endoscopic evaluation of the esophagus and stomach could not be performed. In those patients, intraoperative endoscopy, made through an incision in the cervical esophagus, was standard diagnostic method for examination of the esophagus and stomach.RESULTS: We found synchronous foregut carcinomas in 3 patients (9.7%). In two patients, synchronous carcinomas had been detected during preoperative endoscopic evaluation, and in one (with obstructive carcinoma) using intraoperative endoscopy. In this case, preoperative barium swallow and CT scan did not reveal the existence of second primary tumor within esophagus, despite the fact that small, but T2 carcinoma, was present.CONCLUSION: It is reasonable to use intraoperative endoscopy as a selective screening test in patients with obstructive hypopharyngeal carcinoma.
Aaron, Justin G.; Sobieszczyk, Magdalena E.; Weiner, Shepard D.; Whittier, Susan; Lowy, Franklin D.
Abstract Lactobacillus rhamnosus is commonly found in gastrointestinal flora and used in probiotics but is a rare human pathogen. We report a case of L. rhamnosus endocarditis following upper endoscopy in a frequent consumer of yogurt containing the organism, who required aortic and mitral valve replacement for cure.
M.J.M. Groenen (Marcel)
textabstractGastrointestinal endoscopy has developed rapidly in the last five decades. It started in the sixties, when the first commercial model of the then recently invented fully flexible fiberoptic gastroscope was developed. In the late sixties fiberoptic endoscopes changed to forward viewing, w
Neubauer, André; Wolfsberger, Stefan
Virtual endoscopy is the computerized creation of images depicting the inside of patient anatomy reconstructed in a virtual reality environment. It permits interactive, noninvasive, 3-dimensional visual inspection of anatomical cavities or vessels. This can aid in diagnostics, potentially replacing an actual endoscopic procedure, and help in the preparation of a surgical intervention by bridging the gap between plain 2-dimensional radiologic images and the 3-dimensional depiction of anatomy during actual endoscopy. If not only the endoscopic vision but also endoscopic handling, including realistic haptic feedback, is simulated, virtual endoscopy can be an effective training tool for novice surgeons. In neurosurgery, the main fields of the application of virtual endoscopy are third ventriculostomy, endonasal surgery, and the evaluation of pathologies in cerebral blood vessels. Progress in this very active field of research is achieved through cooperation between the technical and the medical communities. While the technology advances and new methods for modeling, reconstruction, and simulation are being developed, clinicians evaluate existing simulators, steer the development of new ones, and explore new fields of application. This review introduces some of the most interesting virtual reality systems for endoscopic neurosurgery developed in recent years and presents clinical studies conducted either on areas of application or specific systems. In addition, benefits and limitations of single products and simulated neuroendoscopy in general are pointed out.
Bretthauer, Michael; Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D
To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on requirements for high-quality endoscopy reporting systems. The following recommendations are issued: Endoscopy reporting systems must be electronic.Endoscopy reporting systems should be integrated into hospital patient record systems.Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources.Endoscopy reporting systems shall restrict the use of free text entry to a minimum, and be based mainly on structured data entry.Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated.Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically.Endoscopy reporting systems shall enable the inclusion of information on histopathology of detected lesions; patient's satisfaction; adverse events; surveillance recommendations.Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format.Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees.Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.
Dong, Seok Ho
The pancreatobiliary organ is composed of one of the most complicated structures and complex physiological functions among other digestive organs in our body. This is why endoscopic procedure in pancreaticobiliary system requires rather complicated techniques. In International Digestive Endoscopy Network (IDEN) 2012, many interesting pancreatobiliay endoscopy related topics were presented. Basic procedures like endoscopic papillary balloon dilation (EPBD), advanced techniques like endoscopic necrosectomy, prevention and management of post-ERCP pancreatitis, and spyglass system are reviewed in this highlight summary.
Miguel Ángel Molano
Full Text Available En la búsqueda de elementos estructurales que ayuden a comprender el sentido y los fundamentos de la experiencia corporal, se presentan, inicialmente, diversas manifestaciones del reduccionismo del cual la experiencia corporal es objeto, en el marco de la cultura denominada "occidental". Llegaremos luego, en este andar, a un cruce de caminos entre cultura, natura y subjetividad alrededor del cuerpo, en cuya complejidad nos detendremos a revisar las dimensiones y elementos estructurales desde las cuales se configura la experiencia corporal. En esta ruta, aún por explorar profundamente, identificaremos diversas relaciones desde las cuales la Educación Física retomaría elementos para enriquecer y potenciar la experiencia corporal.
The aim of this study is to describe the role of endoscopy in detection and treatment of neoplastic lesions of the digestive mucosa in asymptomatic persons. Esophageal squamous cell cancer occurs in relation to nutritional deficiency and alcohol or tobacco consumption. Esophageal adenocarcinoma develops in Barrett's esophagus, and stomach cancer in chronic gastric atrophy with Helicobacter pylori infection. Colorectal cancer is favoured by a high intake in calories, excess weight, low physical activity. In opportunistic or individual screening endoscopy is the primary detection procedure offered to an asymptomatic individual. In organized or mass screening proposed by National Health Authorities to a population, endoscopy is performed only in persons found positive to a filter selection test. The indications of primary upper gastrointestinal endoscopy and colonoscopy in opportunistic screening are increasingly developing over the world. Organized screening trials are proposed in some regions of China at high risk for esophageal cancer; the selection test is cytology of a balloon or sponge scrapping; they are proposed in Japan for stomach cancer with photofluorography as a selection test; and in Europe, America and Japan; for colorectal cancer with the fecal occult blood test as a selection test. Organized screening trials in a country require an evaluation: the benefit of the intervention assessed by its impact on incidence and on the 5 year survival for the concerned tumor site; in addition a number of bias interfering with the evaluation have to be controlled. Drawbacks of screening are in the morbidity of the diagnostic and treatment procedures and in overdetection of none clinically relevant lesions. The strategy of endoscopic screening applies to early cancer and to benign adenomatous precursors of adenocarcinoma. Diagnostic endoscopy is conducted in 2 steps: at first detection of an abnormal area through changes in relief, in color or in the course of
Seltenreich, H; Van Den Bogaerde, J; Sorrentino, D
In recent years, gastrointestinal endoscopy has evolved and branched out from a primary naked-eye diagnostic technique to a multitude of sophisticated investigative and therapeutic procedures. While many of the new endoscopic techniques are currently too complex or expensive to make it to mainstream clinical practice, others are already bringing major progress to the management of digestive diseases. In this review we will discuss a selected group of the emerging techniques and technologies used to increase the diagnostic yield in the colon and small intestine, including Third Eye® Retroscopes®, colon capsule endoscopy, spiral enteroscopy and confocal laser endomicroscopy. We will also discuss over-the-scope clip devices, a relatively simple and inexpensive tool potentially capable of noninvasive closing intestinal perforations and allowing the removal of infiltrating tumors.
María José LUESMA BARTOLOMÉ
Full Text Available La interdisciplinariedad como estrategia pedagógica, permite corregir la atomización de una ciencia excesivamente individualizada, facilitando la interacción de varias disciplinas encaminada a un conocimiento integral. Y este ha sido el objetivo prioritario planteado en la experiencia piloto que aquí se presenta basada en la metodología del Aprendizaje Basado en Problemas aplicada a las asignaturas de Anatomi?a e Histología Ocular y Fisiología Ocular y del Sistema Visual, impartidas en el primer curso del Grado de Óptica-Optometría. Para ello los estudiantes, asumiendo diferentes roles rotatorios, han resuelto de manera cooperativa problemas teórico-prácticos comunes a ambas asignaturas. En la calificación final se ha tenido en cuenta el contenido correspondiente a cada una de las asignaturas de los portafolios generados durante la resolución de los problemas comunes y de las demás actividades docentes desarrolladas en cada asignatura por separado. Asimismo, se han realizado encuestas a los estudiantes, recogiendo sus expectativas y analizando el grado de satisfacción tras aplicar la metodología innovadora. Los datos indican que se han obtenido mejores resultados de aprendizaje que con otras actividades. En general, los estudiantes se sienten más satisfechos con esta nueva manera de aprender.
Rodin, Vincent; Ayache, Alain; Berreni, N.
This work is related to a project of medical robotics applied to surgical endoscopy, led in collaboration with Doctor Berreni from the Saint Roch nursing-home in Perpignan, France). After taking what Doctor Berreni advises, two aspects of endoscopic color image processing have been brought out: (1) The help to the diagnosis by the automatic detection of the sick areas after a learning phase. (2) The 3D reconstruction of the analyzed cavity by using a zoom.
Mannath, Jayan; Ragunath, Krish
Incidence of oesophageal adenocarcinoma has increased exponentially in the West over the past few decades. Following detection of advanced cancers, 5-year survival rates remain bleak, making identification of early neoplasia, which has a better outcome, important. Detection of subtle oesophageal lesions during endoscopy can be challenging, and advanced imaging techniques might improve their detection. High-definition endoscopy has become a standard in most endoscopy centres, and this technology probably provides better delineation of mucosal features than standard-definition endoscopy. Various image enhancement techniques are now available with the development of new electronics and software systems. Image enhancement with chromoendoscopy using dyes has been a cost-effective option for many years, yet these techniques have been replaced in some contexts by electronic chromoendoscopy, which can be used with the press of a button. However, Lugol's chromoendoscopy remains the gold standard to identify squamous dysplasia. Identification and characterization of subtle neoplastic lesions could help to target biopsies and perform endoscopic resection for better local staging and definitive therapy. In vivo histology with techniques such as confocal endomicroscopy could make endotherapy feasible within a shorter timescale than when relying on histology on tissue samples. Once early neoplasia is identified, treatments include endoscopic resection, endoscopic submucosal dissection or various ablative techniques. Endotherapy has the advantage of being a less invasive technique than oesophagectomy, and is associated with lower mortality and morbidity. Endoscopic ablation therapies have evolved over the past few years, with radiofrequency ablation showing the best results in terms of success rates and complications in Barrett dysplasia.
Full Text Available Background: Intracranial endoscopy is a minimum invasive procedure, which reduces trauma to the brain, is cost-effective, and carries a shortened hospital stay with an improved postoperative outcome. Objective: To monitor intracranial pressure changes during intracranial endoscopy among children and adults under general anesthesia/sedation, and to compare the intracranial pressure changes between children and adults receiving general anesthesia and among adults receiving general anesthesia and sedation. Methods: The present cross-sectional study was conducted in one of the tertiary care hospitals of Lucknow. This was carried out in the department of neurosurgery from January 2008 to December 2008. Patients who were not fit for general anesthesia received local anesthesia under sedation. Patients participating in the study were divided into three groups. Intracranial pressure was recorded at specific intervals. Parametric data were subjected to statistical analysis using a student\\s t test. Result: A total of 70 patients were undergoing intracranial endoscopy under general anesthesia during the study period. In both groups A and B, intracranial pressure increases the maximum during inflation of the balloon. In group C, all the variations in ICP were found to be statistically significant. In the comparison of intracranial pressure changes between groups A and B, no significant difference was found. All correlations in the comparison of groups B and C were found to be statistically significant (p< 0.001. Conclusion: There is a need for continuous intraoperative monitoring of ICP intracranial endoscopy, because ICP increases in various stages of the procedure, which can be detrimental to the perfusion of the brain. [Arch Clin Exp Surg 2013; 2(4.000: 240-245
Full Text Available This 2014 roundtable discussion, hosted by the Canadian Association of General Surgeons, brought together general surgeons and gastroenterologists with expertise in endoscopy from across Canada to discuss the state of endoscopy in Canada. The focus of the roundtable was the evaluation of the competence of general surgeons at endoscopy, reviewing quality assurance parameters for high-quality endoscopy, measuring and assessing surgical resident preparedness for endoscopy practice, evaluating credentialing programs for the endosuite and predicting the future of endoscopic services in Canada. The roundtable noted several important observations. There exist inadequacies in both resident training and the assessment of competency in endoscopy. From these observations, several collaborative recommendations were then stated. These included the need for a formal and standardized system of both accreditation and training endoscopists.
Pignon, Charly; Huynh, Minh; Husnik, Roman; Jekl, Vladimir
Gastrointestinal disease is a common complaint in ferrets (Mustela putorius furo). Their relatively simple and short gastrointestinal tract makes them good candidates for flexible endoscopy. However, apart from a few references in biomedical research articles, there is little information on the use of flexible endoscopy in ferrets. This review describes patient preparation, equipment, and select gastrointestinal endoscopy techniques in ferrets, including esophagoscopy, gastroscopy, duodenoscopy, percutaneous endoscopic gastrostomy, jejunoileoscopy, colonoscopy, and biopsy.
Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D
To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE’s viewpoints on requirements for high-quality endoscopy reporting systems. The following recommendations are issued: Endoscopy reporting systems must be electronic.Endoscopy reporting systems should be integrated into hospital patient record systems.Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources.Endoscopy reporting systems shall restrict the use of free text entry to a minimum, and be based mainly on structured data entry.Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated.Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically.Endoscopy reporting systems shall enable the inclusion of information on histopathology of detected lesions; patient’s satisfaction; adverse events; surveillance recommendations.Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format.Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees.Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations. PMID:27087943
Castillo Saornil, Santos
Tesina titulada "Una experiencia del atletismo en Cantabria" del autor Santos Castillo Saornil y dirigida por el profesor Jesús Patricio Durán Piqueras. Instituto Nacional de Educación Física, curso 1983-1984. Consta de los siguientes capítulos: enseñanza del atletismo, iniciación al atletismo, la lección de iniciación al atletismo, iniciación a las carreras, experiencias personales, conclusiones y bibliografía.
Santalucita, F.; Aragón, M.; Chiarelli, P.
Esta experiencia se realizo en la ciudad La Plata en el año 2002 en el Parque Ecológico de esa ciudad luego en el 2003, nos invitaron a participar en la institución, La Republica de los Niños de dicha ciudad, hasta mediados de 2008. La experiencia estuvo dirigida a niños entre 4 y 10 años, ofreciendo una visión sobre nuevas teorías, descripción de los diferentes taxones, procesos evolutivos de los diferentes grupos, creímos conveniente introducir otros temas relacionados, como Deriva continen...
Triantafillidis, John K; Merikas, Emmanuel; Nikolakis, Dimitrios; Papalois, Apostolos E
Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.
Jensen, J T; Vilmann, P; Horsted, T
BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program. PATIENTS AND METHODS: A structured training program was developed both for endosco...... for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy....
Metcalf, R; Tate, R
Studies have indicated that active participation by employees improves job satisfaction and performance. There is a sense of pride and accountability that is demonstrated in the work environment when staff are involved in the decision-making process. Recent emergence of a relatively new philosophy for management that promotes employee ownership is shared governance. This type of leadership allows individuals who are at the center of the work place to participate in the decisions that actively reflect their needs. In this article, the authors describe the process of implementing shared governance in an Endoscopy Department. The effectiveness of shared governance is evidenced by the renewed enthusiasm and energy demonstrated by the staff.
Hendel, J.W.; Vilmann, P.; Jensen, T.
Objective. Double-balloon endoscopy (DBE) made the small bowel accessible to inspection and therapy in its entirety. However, DBE is a time-consuming procedure that requires a highly skilled endoscopist, several nurses and - more often than not - anesthesiological support. This makes the selectio...... within the next 12 months. Conclusions. CE can be applied as a screening procedure for DBE and allows for an approximately two-thirds reduction in the need for DBE as well as enabling a choice to be made between the oral and anal route Udgivelsesdato: 2008...
las implicaciones del paro en contextos caracterizadas por la presencia o ausencia de dispositivos de protección social. Se concluye que los consecuencias no económicas del paro actual pueden ser tan graves como lo fueron durante la Gran Depresión. Dada la relevancia que algunos economistas atribuyen a los sistemas de protección del desempleo en la explicación del nivel y duración del paro europeo, en la segunda porte se analiza la teoría de la búsqueda de empleo y sus implicaciones para la política de mercado de trabajo a la luz de la literatura sobre la experiencia de paro. Se concluye que los recortes en los dispositivos de protección tienen, en el mejor de los casos, efectos positivos muy limitados sobre el paro y que podrían verse contrarrestados por efectos de signo contrario sobre las condiciones de trabajo, localidad de vida de los parados y el grado de cohesión social. En una situación coma la española habría que dar prioridad a las políticas activas de empleo, al tratamiento personalizado de los parados y a la persecución del fraude empresarial a la Seguridad Social
Diana Melisa Paredes Oviedo
Full Text Available La experiencia estética se constituye en un elemento crucial para la obra de John Dewey. En primer lugar, este pensador recupera la idea de experiencia, en sentido amplio, referida a los procesos conscientes realizados por el ser humano. En segundo lugar, esta experiencia aparece como resultado de la interacción de los hombres con su entorno, de tal modo que se amplían las valoraciones que aquellos tienen acerca de éste. En tercer lugar, la experiencia tiene elementos analíticos y sintéticos que posibilitan cualificar los procesos cognitivos y cognoscitivos de los individuos. En cuarto lugar, la experiencia se clasifica de acuerdo a su función en intelectual, práctica y estética, siendo la última la más importante, en tanto que, se muestra como más universal y ampliada frente a las otras, y se comporta como experiencia educativa al ser la que cualifica de manera más profunda los juicios críticos que se hacen frente al mundo.Los anteriores aspectos serán trabajados en este artículo, con miras a explorar la universalidad de la experiencia estética deweyana y sus derivaciones en el campo de una propuesta educativa, en la que resulta de vital importancia la existencia de una experiencia común entre los diferentes grupos humanos para lograr configurar la inteligencia común que es la base para la educación en John Dewey.
En este proyecto se investiga el uso y la aplicación de la experiencia (publicidad y comunicación) en el sector de la moda. La unión e interacción de ambos da lugar a las concept store, sedes donde el entrenamiento y la experiencia son los pilares básicos para fidelizar a los consumidores.
Mildred Carmen Meza Chávez
Full Text Available Este trabajo expone una experiencia investigativa donde se presentan alternativas de solución para el problema de las relaciones escuela-escuela. Desde esta perspectiva, se realiza un análisis bajo diez criterios considerados por Blanco y Messina (2000 que, a grandes rasgos, dan cuenta de las principales características de las innovaciones educativas. El análisis de esta experiencia es concluyente al registrar este tipo de innovación como una innovación social al entender el carácter social de la innovación en doble sentido, es decir: por la naturaleza del cambio en condiciones objetivas, que se logran por hacer algo de manera distinta y por la naturaleza del cambio en condiciones subjetivas, dada por la experiencia de vida que los participantes incorporan durante la dinámica innovadora. En este sentido, esta experiencia transformadora puede ser considerada como una: innovación social que la entendemos como la adquisición de competencias organizacionales para propiciar vías modificadoras con la finalidad de fortalecer la interacción escuela - entorno.
van Dijk, C.N.; de Leeuw, P.A.J.; Scholten, P.E.
BACKGROUND: The surgical treatment of posterior ankle impingement is associated with a high rate of complications and a substantial time to recover. An endoscopic approach to the posterior ankle (hindfoot endoscopy) may lack these disadvantages. We hypothesized that hindfoot endoscopy causes less mo
Rahman, Imdadur; Patel, Praful; Boger, Philip; Rasheed, Shahnawaz; Thomson, Mike; Afzal, Nadeem Ahmad
Since the first report of use of endoscopy in children in the 1970s, there has seen an exponential growth in published experience and innovation in the field. In this review article we focus on modern age therapeutic endoscopy practice, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the paediatric upper gastrointestinal tract.
ter Laan, Mark; Totte, Erik; van Hulst, Rob A.; van der Linde, Klaas; van der Kamp, Wim; Pierie, Jean-Pierre E.
Cerebral gas embolism as a result of upper gastrointestinal endoscopy is a rare complication and bares a high morbidity. A patient is presented who underwent an upper endoscopy for evaluation of a gastric-mediastinal fistula after subtotal oesophagectomy and gastric tube reconstruction because of oe
George K Anagnostopoulos; Krish Ragunath; Anthony Shonde; Christopher J Hawkey; Kenshi Yao
Endoscopic visualisation of gastric atrophy is usually not feasible with conventional endoscopy. Magnifying endoscopy is helpful to analyze the subepithelial microvascular architecture as well as the mucosal surface microstructure without tissue biopsy. Using this technique we were able to describe the normal gastric microvasculature pattern and we also identified characteristic patterns in two cases of autoimmune atrophic gastritis.
ter Laan, Mark; Totte, Erik; van Hulst, Rob A.; van der Linde, Klaas; van der Kamp, Wim; Pierie, Jean-Pierre E.
Cerebral gas embolism as a result of upper gastrointestinal endoscopy is a rare complication and bares a high morbidity. A patient is presented who underwent an upper endoscopy for evaluation of a gastric-mediastinal fistula after subtotal oesophagectomy and gastric tube reconstruction because of oe
George C. Kagadis; Dimitrios Siablis; Evangelos N. Liatsikos; Theodore Petsas; George C. Nikiforidis
Technological breakthroughs have advanced the temporal and spatial resolutions of diagnostic imaging, and 3 dimensional (3-D) reconstruction techniques have been introduced into everyday clinical practice. Virtual endoscopy (VE)is a non-invasive technique that amplifies the perception of cross-sectional images in the 3-D space, providing precise spatial relationships of pathological regions and their surrounding structures. A variety of computer algorithms can be used to generate 3-D images, taking advantage of the information inherent in either spiral computed tomography or magnetic resonance imaging (MRI). VE images enable endoluminal navigation through hollow organs, thus simulating conventional endoscopy. Several clinical studies have validated the diagnostic utility of virtual cystoscopy, which has high sensitivity and specificity rates in the detection of bladder tumor. Published experience in the virtual exploration of the renal pelvis, ureter and urethra is encouraging but still scarce. VE is a safe, non-invasive method that could be applied in the long-term follow-up of patients with ureteropelvic junction obstruction, urinary bladder tumors and ureteral and/or urethral strictures. Its principal limitations are the inability to provide biopsy tissue specimens for histopathologic examination and the associated ionizing radiation hazards (unless MRI is used). However, in the case of endoluminal stenosis or obstruction, VE permits virtual endoluminal navigation both cephalad and caudal to the stenotic segment. To conclude, VE provides a less invasive method of evaluating the urinary tract, especially for clinicians who are less familiar with cross-sectional imaging than radiologists.
Full Text Available Background. Esophagogastroduodenoscopy (EGD and colonoscopy (CS can evoke anxiety, embarrassment, and discomfort. These concerns can culminate in panic attacks, which may traumatize patients and significantly decrease their compliance to the procedure. The objective of this study was to evaluate the relationship between preendoscopic anxiety and the possibility of a panic attack during an elective gastrointestinal endoscopy (EGE. Methods. The study population comprised of 79 Greek outpatients. The examination was carried out without the use of conscious sedation. Patients' anxiety levels were assessed before the procedure using the Greek version of the Spielberger State-Trait Anxiety Inventory (STAI-Y. Results. Seventy-nine patients were enrolled: 45 EGD and 34 CS. Females had higher state and trait anxiety levels than males (48.14 ± 7.94 versus 44.17 ± 7.43, <0.05; and 43.68 ± 6.95 versus 39.86 ± 7.46, <0.05. Patients who experienced panic attack had significantly higher levels of both trait and state anxiety, compared to those who were panic-free. There was no significant relationship between panic attacks and sex or type of procedure. Conclusions. Patients who experience panic attacks during endoscopic procedures appear to have significantly higher anxiety levels before the procedure. Administering the STAI questionnaire prior to the endoscopy seems to be a useful screening method for vulnerable patients.
Basavana Gouda Goudra
Full Text Available Although propofol has been the backbone for sedation in gastrointestinal endoscopy, both anesthesiologists and endoscopists are faced with situations where an alternative is needed. Recent national shortages forced many physicians to explore these options. A midazolam and fentanyl combination is the mainstay in this area. However, there are other options. The aim of this review is to explore these options. The future would be, invariably, to move away from propofol. The reason is not in any way related to the drawbacks of propofol as a sedative. The mandate that requires an anesthesia provider to administer propofol has been a setback in many countries. New sedative drugs like Remimazolam might fill this void in the future. In the meantime, it is important to keep an open eye to the existing alternatives.
Donatsky, Anders Meller; Holzknecht, Barbara Juliane; Arpi, Magnus
BACKGROUND: One of the biggest concerns associated with transgastric surgery is contamination and risk of intra-abdominal infection with microbes introduced from the access route. The purpose of this study was to evaluate the effect of oral decontamination with chlorhexidine on microbial contamin......BACKGROUND: One of the biggest concerns associated with transgastric surgery is contamination and risk of intra-abdominal infection with microbes introduced from the access route. The purpose of this study was to evaluate the effect of oral decontamination with chlorhexidine on microbial...... contamination of the endoscope. METHODS: In a prospective, randomized, single-blinded, clinical trial the effect of chlorhexidine mouth rinse was evaluated. As a surrogate for the risk of intra-abdominal contamination during transgastric surgery, microbial contamination of the endoscope during upper endoscopy...... microbial contamination of the endoscope, but micro-organisms with abscess forming capabilities were still present. PPI treatment significantly increased CFU and should be discontinued before transgastric surgery....
Hyun Joo Song
Full Text Available During video capsule endoscopy (VCE, several factors, such as air bubbles, food material in the small bowel, and delayed gastric and small bowel transit time, influence diagnostic yield, small bowel visualization quality, and cecal completion rate. Therefore, bowel preparation before VCE is as essential as bowel preparation before colonoscopy. To date, there have been many comparative studies, consensus, and guidelines regarding different kinds of bowel cleansing agents in bowel preparation for small bowel VCE. Presently, polyethylene glycol- (PEG- based regimens are given primary recommendation. Sodium picosulphate-based regimens are secondarily recommended, as their cleansing efficacy is less than that of PEG-based regimens. Sodium phosphate as well as complementary simethicone and prokinetics use are considered. In this paper, we reviewed previous studies regarding bowel preparation for small bowel VCE and suggested optimal bowel preparation of VCE.
Williams, T; Ross, A; Stirling, C; Palmer, K; Phull, P S
The Global Rating Scale for endoscopy is a web-based tool that can be used to assess and improve the quality of an endoscopy service. It was developed by asking endoscopy health professionals what they would want from the service for themselves or their relatives if they were undergoing an endoscopic procedure. To date, the Global Rating Scale has not been validated by patients themselves. We used focus groups in order to access the views and opinions of patients who had recently had experience of endoscopy services. Six focus groups were undertaken in five different Health Board areas across Scotland; in total 26 people participated. The results indicated that from the patients' perspective the 12 items of the GRS covered all areas of the endoscopy experience. There were no specific concerns identified that were not already covered within the Global Rating Scale. We conclude that the Global Rating Scale does address quality issues that matter to patients undergoing endoscopy, and validates the use of the GRS as a quality assessment tool for endoscopy services.
Ellingson, Derek; Miick, Ronald; Chang, Faye; Hillard, Robert; Choudhary, Abhishek; Ashraf, Imran; Bechtold, Matthew; Diaz-Arias, Alberto
The diagnostic yield in open access endoscopy has been evaluated which generally support the effectiveness and efficiency of open access endoscopy. With a few exceptions, diagnostic yield studies have not been performed in open access endoscopy for more specific conditions. Therefore, we conducted a study to determine the efficiency of open access endoscopy in the detection of microscopic colitis as compared to traditional referral via a gastroenterologist. A retrospective search of the pathology database at the University of Missouri for specimens from a local open access endoscopy center was conducted via SNOMED code using the terms: "microscopic", "lymphocytic", "collagenous", "spirochetosis", "focal active colitis", "melanosis coli" and "histopathologic" in the diagnosis line for the time period between January 1, 2004 and May 25, 2006. Specimens and colonoscopy reports were reviewed by a single pathologist. Of 266 consecutive patients with chronic diarrhea and normal colonoscopies, the number of patients with microscopic disease are as follows: Lymphocytic colitis (n = 12, 4.5%), collagenous colitis (n = 17, 6.4%), focal active colitis (n = 15, 5.6%), and spirochetosis (n = 2, 0.4%). The diagnostic yield of microscopic colitis in this study of an open access endoscopy center does not differ significantly from that seen in major medical centers. In terms of diagnostic yield, open access endoscopy appears to be as effective in diagnosing microscopic colitis.
Collins, Paul D
Video capsule endoscopy (VCE) has evolved to become an important tool for the non-invasive examination of the small bowel, which hitherto had been relatively inaccessible to direct visualisation. VCE has been shown to play a role in monitoring the activity of small bowel Crohn’s disease and can be used to assess the response to anti-inflammatory treatment in Crohn’s disease. For those patients with Crohn’s disease who have undergone an intestinal resection, VCE has been assessed as a tool to detect post-operative recurrence. VCE may also aid in the reclassification of patients with a diagnosis of Inflammatory Bowel Disease Unclassified to Crohn’s disease. The evolution of colon capsule endoscopy (CCE) has expanded the application of this technology further. The use of CCE to assess the activity of ulcerative colitis has been described. This advance in capsule technology has also fuelled interest in its potential role as a minimally invasive tool to assess the whole of GI tract opening the possibility of its use for the panenteric assessment of Crohn’s disease. VCE is a safe procedure. However, the risk of a retained capsule is higher in patients with suspected or confirmed Crohn’s disease compared with patients having VCE examination for other indications. A retained video capsule is rare after successful passage of a patency capsule which may be utilised to pre-screen patients undergoing VCE. This paper describes the use of VCE in the assessment of inflammatory bowel disease. PMID:27499830
Rosa, Bruno; Cotter, José
Small bowel capsule endoscopy is currently the first line diagnostic examination for many diseases affecting the small bowel. This article aims to review and critically address the current indications of small bowel capsule endoscopy in clinical practice. Bibliographic review of relevant and recent papers indexed in PubMed. Small bowel capsule endoscopy enables a non-invasive full-assessment of the small bowel mucosa, with high diagnostic yield even for subtle lesions. In patients with obscure gastrointestinal bleeding, diagnostic yield is higher when performed early after the onset of bleeding. Endoscopic treatment of angioectasias using balloon-assisted enteroscopy may contribute to reduce rebleeding, while the risk of rebleeding in patients with 'negative' small bowel capsule endoscopy is debatable. Cross-sectional imaging may be more accurate than small bowel capsule endoscopy for the diagnosis of large small bowel tumors. The Smooth Protruding Index on Capsule Endoscopy (SPICE score) may help to differentiate submucosal tumors from innocent bulges. Small bowel capsule endoscopy is also a key diagnostic instrument in patients with suspected Crohn's disease and non-diagnostic ileocolonoscopy; it may also influence prognosis and therapeutic management, by determining disease extent and activity in patients with known Crohn's disease. The role of small bowel capsule endoscopy to investigate possible complications in patients with non-responsive coeliac disease is evolving. Small bowel capsule endoscopy is a valuable diagnostic instrument for patients with obscure gastrointestinal bleeding and/or suspected small bowel tumors; it may also be a key examination in patients with suspected Crohn's disease, or patients with known Crohn's disease to fully assess disease extension and activity; finally, it may contribute for the diagnosis of complications of non-responsive coeliac disease.
Chung, Hyun Kee; Lightdale, Jenifer R
Sedation is a fundamental component of pediatric gastrointestinal procedures. The 2 main types of sedation for pediatric endoscopy remain general anesthesia and procedural sedation. Although anesthesiologist-administered sedation protocols are more common, there is no ideal regimen for endoscopy in children. This article discusses specific levels of sedation for endoscopy as well as various regimens that can be used to achieve each. Risks and considerations that may be specific to performing gastrointestinal procedures in children are reviewed. Finally, potential future directions for sedation and monitoring that may change the practice of pediatric gastroenterology and ultimately patient outcomes are examined.
Desmarchelier, Marion R; Ferrell, Shannon T
Although endoscopy is part of the basic standard of care in most avian practices, many wildlife rehabilitation centers do not have access to the equipment or do not use it on a regular basis. Endoscopic equipment is easily available at a lower cost on the used market or can be acquired through donations from local human hospitals. Several medical conditions encountered in wild raptors have an improved prognosis if they are diagnosed or treated early with the aid of endoscopy. In many cases, endoscopy provides a noninvasive alternative to exploratory surgery, saving cost and time and decreasing postoperative pain.
Escribano Ródenas, M.C.
Full Text Available Esta comunicación pretende mostrar la experiencia llevada a cabo en la asignatura “Matemáticas” en los cursos primero y cuarto de las licenciaturas en CC. Económicas y Administración y Dirección de Empresas, durante los cursos académicos 1.997/98 y cursos anteriores. El objetivo de la experiencia en primer curso es intentar realizar un repaso de lo más esencial visto por los alumnos en cursos anteriores y establecer unos mínimos de partida para la asignatura “Matemáticas”, de estas dos licenciaturas. La iniciativa fue del Departamento. En cuarto curso la experiencia se ha llevado a cabo a propuesta de los alumnos, y su objetivo ha sido realizar un repaso de la programación matemática vista en el primer curso de carrera, siendo ésta un instrumento necesario para una asignatura de cuarto curso de la licenciatura en Administración y Dirección de Empresas, denominada “Teoría y Métodos de Decisión”.
Bond, Ashley; Burkitt, Michael D; Cox, Trevor; Smart, Howard L; Probert, Chris; Haslam, Neil; Sarkar, Sanchoy
In the UK, the majority of diagnostic upper gastrointestinal (UGI) endoscopies are a result of direct-to-test referral from the primary care physician. The diagnostic yield of these tests is relatively low, and the burden high on endoscopy services. Dual-focus magnification, high-definition endoscopy is expected to improve detection and classification of UGI mucosal lesions and also help minimize biopsies by allowing better targeting. This is a retrospective study of patients attending for direct-to-test UGI endoscopy from January 2015 to June 2015. The primary outcome of interest was the identification of significant pathology. Detection of significant pathology was modelled using logistic regression. 500 procedures were included. The mean age of patients was 61.5 (±15.6) years; 60.8% of patients were female. Ninety-four gastroscopies were performed using dual-focus magnification high-definition endoscopy. Increasing age, male gender, type of endoscope, and type of operator were all identified as significant factors influencing the odds of detecting significant mucosal pathology. Use of dual-focus magnification, high-definition endoscopy was associated with an odds ratio of 1.87 (95%CI 1.11-3.12) favouring the detection of significant pathology. Subsequent analysis suggested that the increased detection of pathology during dual-focus magnification, high-definition endoscopy also influenced patient follow-up and led to a 3.0 fold (p=0.04) increase in the proportion of patients entered into an UGI endoscopic surveillance program. Dual-focus magnification, high-definition endoscopy improved the diagnostic yield for significant mucosal pathology in patients referred for direct-to-test endoscopy. If this finding is recapitulated elsewhere it will have substantial impact on the provision of UGI endoscopic services.
Kovaleva, Julia; Peters, Frans T. M.; van der Mei, Henny C.; Degener, John E.
Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by
AIM: To review and summerize the current literatue regarding M2A wireless capsule endoscopy.METHODS: Peer reviewed publications regarding the use of capsule endoscopy as well as our personal experience were reviewed.RESULTS: Review of the literature dearly showed that capsule endoscopy was superior to enteroscopy, small bowel follow through and computerized tomography in patients with obscure gastrointestinal bleeding, iron deficiency anemia,or suspected Crohn′s disease. It was very sensitive for the diagnosis of small bowel tumors and for survailance of small bowel pathology in patients with Gardner syndrome or familial adenomatous polyposis syndrome. Its role in celiac disease and in patients with known Crohn′s disease was currently being investigated.CONCLUSION: Capsule video endoscopy is a superior and more sensitive diagnostic tool than barium follow through,enteroscopy and entero- CT in establishing the diagnosis of many small bowel pathologies.
Kovaleva, Julia; Peters, Frans T. M.; van der Mei, Henny C.; Degener, John E.
Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by
GUIDELINE Guidelines for endoscopy in pregnant and lactating women This is one of a series of statements discussing the ... text. This guide- line updates a previously issued guideline on this topic. 1 In preparing this guideline, ...
Feb 2, 2015 ... for an elderly patient with acute upper gastrointestinal bleeding. ... Peer review under responsibility of Alexandria University Faculty of. Medicine. ... endoscopy, the patient suffered an ischemic-cerebrovascular stroke leaving ...
Fanti, Lorella; Testoni, Pier Alberto
Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures. The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated. Providing an adequate regimen of sedation/analgesia might be considered an art, influencing several aspects of endoscopic procedures: the quality of the examination, the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation. The properties of a model sedat...
Lorella; Fanti; Pier; Alberto; Testoni
Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endosc...
Tetzlaff, John E; Vargo, John J; Maurer, Walter
Anesthesia services are increasingly being requested for gastrointestinal (GI) endoscopy procedures. The preparation of the patients is different from the traditional operating room practice. The responsibility to optimize comorbid conditions is also unclear. The anesthetic techniques are unique to the procedures, as are the likely events that require intervention by the anesthesia team. The postprocedure care is also unique. The future needs for anesthesia services in GI endoscopy suite are likely to expand with further developments of the technology.
Guimarães, A V; Brandão, L G; Dedivitis, R A
Aim of this study was to analyse contact endoscopy as an auxiliary method for identifying parathyroid glands during thyroid surgery and to identify other variables that may interfere with this correlation. Overall, 125 patients underwent thyroid surgery between January 2004 and February 2006. The variables analysed were: the total duration of surgery; time taken to locate and identify parathyroid glands; improvement in identifying these; numbers of parathyroid glands located by the surgeon and confirmed by contact endoscopy; histopathological diagnosis; presence of thyroiditis; thyroid weight; number of parathyroid glands left in thyroid specimens; and number of parathyroid gland autotransplantations. A total of 331 parathyroid glands were observed by the surgeon. However, 282 glands were identified by contact endoscopy. Nine parathyroid glands (7.2%) were observed together with thyroid specimens (Kappa = 0.534). The longer the total duration of surgery (p = 0.03) and time taken to locate and identify (p = 0.00) the parathyroid glands by contact endoscopy, the lower the observed agreement. The second year of performing contact endoscopy led to better agreement between the results (p = 0.02). In conclusion, contact endoscopy is an efficient auxiliary method for identifying parathyroid glands during thyroid surgery. During the period studied, association between total duration of surgery and time taken to locate and identify parathyroid glands was statistically significant.
Beckett, Ronald G
The use of endoscopy in anthropological and archaeological research was been well documented in the literature. This article explores the varied settings in which endoscopy is beneficial in gathering visual data for interpretation related to cultural remains and artifacts. Endoscopic data may be used to assist in the pursuit of answering such bioanthropological questions as sex, age at death, presence of paleopathologies, dental conditions, and cultural practices. Endoscopy is often used to guide and document biopsy procedures as well as the retrieval of artifacts from within poorly accessible locations such as body cavities, coffins, or tombs. In addition, endoscopic data is used to examine such archaeological features as tomb structure and design. A contrast between the medical and anthropological approach is described. Endoscopic research is enhanced when applied in conjunction with additional varied imaging modalities. While invasive, endoscopy is a nondestructive methodological approach. As with all methods, endoscopy has application and interpretational limitations, which can be described as limitations resulting from instrumentation, and those arising from personnel less familiar with the various approaches to endoscopy in both field and laboratory settings. © 2015 Wiley Periodicals, Inc.
Alejandro Parra; Juan Carlos Argibay
Hay interrelaciones estadísticamente confiables entre la susceptibilidad a la hipnosis, la disociación psicológica y las experiencias paranormales. Hipotetizamos que a mayor susceptibilidad hipnótica, mayor reporte de experiencias paranormales, y en igual sentido, a mayores experiencias disociativas, mayor reporte de experiencias paranormales. También esperamos encontrar posibles efectos de interacción entre susceptibilidad hipnótica y disociación con las experiencias paranormales...
Morozov, Vadim; Nezhat, Ceana
As minimally invasive surgery becomes the standard of care in the United States and around the world, the formal training of endoscopic surgeons is an issue of growing concern. With the implementation of the American Association of Gynecologic Laparoscopists/Society of Reproductive Surgeons (AAGL/SRS)-sponsored fellowship training in gynecologic endoscopy and a growing number of hands-on courses, we have the challenge of credentialing and certifying future gynecologic endoscopists. The objective of this article is to propose and to illustrate a uniform standardized core curriculum for obstetrics and gynecology residents, fellows in AAGL/SRS-sponsored fellowship programs, and participants in postgraduate courses. Consisting of 3 discrete parts, this proposal addresses formal laparoscopic training for gynecologists, already implemented and available to general surgeons, and a novel proposition for core training in hysteroscopy. The curriculum is distributed in a quarterly system with specific educational objectives in each quarter. After quarters 1 and 2, an online examination is given; after quarter 3, participants are required to take and pass a hands-on examination at a specified testing facility; and at the end of quarter 4, participants must demonstrate leadership skills in the operating room and in a teaching capacity, and promote the principles of the AAGL.
Full Text Available Background:Gastroenterologists are required to obtain consent before undertaking any endoscopic examination.Published data indicate that in practice there are many deficiencies in this process.The aim of this survey was to determine the quality of information given to patients before the endoscopic procedures in Iran.Methods:A structured questionnaire about patient's informed consent before endoscopy was used.In the 3rd Iranian international congress of gastroenterology and hepatology ,100 endoscopists (gastroenterologist or internistparticipated in this study regarding the quality of informed consent.Results: 90% of these physicians were male and 57% of them worked in Tehran (capital of Iran. The distribution of positive answers were as follow :Detailed information regarding the nature of the endoscopic procedure provided to the patient, 91%; the sufficient time to ask questions about the nature of the procedure, 82% ; alternative diagnostic tests or treatment explained to the patient,73%; patient informed about the possible complications of the proposed procedure, 32%; the patient informed about the mortality rate of the proposed endoscopic procedure, 15%. Conclusion: Although information about the procedure is given to the patients in 91% of the procedure,endoscopic practice must respect the ethical aspects of medicine and more attention need to be paid to informed consent and patient's information, especially about potential procedure- related complication and mortality.
The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities. Additionally, appropriate selection and preparation of patients, suitable sedative technique, application of drugs, adequate monitoring, and proper recovery of patients is essential. The goal of procedural sedation is the safe and effective control of pain and anxiety as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation practices for gastrointestinal endoscopy (GIE) vary widely. The majority of GIE patients are ambulatory cases. Most of this procedure requires a short time. So, short acting, rapid onset drugs with little adverse effects and improved safety profiles are commonly used. The present review focuses on commonly used regimens and monitoring practices in GIE sedation. This article is to discuss the decision making process used to determine appropriate pre-sedation assessment, monitoring, drug selection, dose of sedative agents, sedation endpoint and post-sedation care. It also reviews the current status of sedation and monitoring for GIE procedures in Thailand.
Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient's age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management.
Seong Ran Jeon
Full Text Available Portal hypertensive enteropathy (PHE is a mucosal abnormality of the small bowel that is observed in patients with portal hypertension (PH and can lead to gastrointestinal bleeding and anemia. The pathogenesis is still not completely understood. The introduction of new endoscopic methods, including capsule endoscopy (CE or balloon-assisted enteroscopy, has increased the detection of these abnormalities. CE can also serve as a road map for deciding subsequent interventions and evaluating the treatment effect. The prevalence of PHE is reportedly 40–70% in patients with PH. Endoscopic findings can be roughly divided into vascular and nonvascular lesions such as inflammatory-like lesions. Traditionally, PHE-associated factors include large esophageal varices, portal hypertensive gastropathy or colopathy, Child-Turcotte-Pugh class B or C, a history of variceal treatment, and acute gastrointestinal bleeding. More recently, on using scoring systems, a high computed tomography or transient elastography score was reportedly PHE-related factors. However, the prevalence of PHE and its related associated factors remain controversial. The management of PHE has not yet been standardized. It should be individualized according to each patient’s situation, the availability of therapy, and each institutional expertise.
Juan Ignacio García Rodríguez
Full Text Available Expone la experiencia chilena sobre el establecimiento y regulación de las franjas electorales, para lo cual analiza la constitucionalidad de la franja, los principios involucrados, las disposiciones regulatorias, el papel del Consejo Nacional de Televisión, la jurisprudencia que sobre el tema ha sido emitida por el Tribunal Calificador de Elecciones y los retos que el sistema de franjas electorales enfrenta a futuro como lo es su aplicación a las elecciones primarias de los partidos políticos.
Con la ponencia denominada: “La experiencia educativa con menores infractores sancionados”, Daniel Cuadra, coordinador del centro para la ejecución de la medida sancionadora de convivencia en grupo educativo de la Asociación Meridianos, ha analizado la labor de los grupos de convivencia en el sistema de reforma juvenil de la Junta de Andalucía. En particular, ha explicado las causas que llevan a los menores a la delincuencia y el tratamiento integral que reciben en los centros. De igual forma...
Medina Sandova, Waldy; Gutiérrez Ruiz, Ana Gabriela
La Humanidad está en un momento crucial en la toma de decisiones ante la crisis ambiental producida por el ser humano, así como por el inminente cambio climático al que se debe enfrentar y adaptar. Costa Rica tiene el reto de implementar un modelo de sostenibilidad en el que el aporte individual es decisivo para lograr un cambio en el objeto del deseo personal y en el que la educación juega un papel fundamental, ya que se debe educar con conciencia planetaria por medio de ricas experiencias.L...
Houlne, M.; Zalazar, M.; Sagaz, A.; López Laur, José Daniel
Objetivos: analizar la experiencia obtenida y evaluar los resultados urodinámicos del estudio de 18 pacientes con esclerosis múltiple. Material y Métodos: se estudiaron 18 casos, valorándose la historia clínica, ecografía vesical y renal, analizándolos urodinámicamente con uroflujometría, residuo post miccional (RPM), cistotonometría y electromiografía esfinteriana. Urocultivo y antibiograma de orina. Resultados: del análisis de toda...
Proaño Cadena, Gaston Nicolas
Red Temática Iberoamericana CYTED Programa A4D.Experiencias en Trabajos de Movimiento de Masa y Taludes.Deslizamiento Río Centro los Ceibos Red Temática Iberoamericana CYTED Programa A4D.Experiencias en Trabajos de Movimiento de Masa y Taludes.Deslizamiento Río Centro los Ceibos
An, Yong Hwan; Hwang, Sae; Oh, JungHwan; Lee, JeongKyu; Tavanapong, Wallapak; de Groen, Piet C.; Wong, Johnny
Advances in video technology are being incorporated into today"s healthcare practice. For example, colonoscopy is an important screening tool for colorectal cancer. Colonoscopy allows for the inspection of the entire colon and provides the ability to perform a number of therapeutic operations during a single procedure. During a colonoscopic procedure, a tiny video camera at the tip of the endoscope generates a video signal of the internal mucosa of the colon. The video data are displayed on a monitor for real-time analysis by the endoscopist. Other endoscopic procedures include upper gastrointestinal endoscopy, enteroscopy, bronchoscopy, cystoscopy, and laparoscopy. However, a significant number of out-of-focus frames are included in this type of videos since current endoscopes are equipped with a single, wide-angle lens that cannot be focused. The out-of-focus frames do not hold any useful information. To reduce the burdens of the further processes such as computer-aided image processing or human expert"s examinations, these frames need to be removed. We call an out-of-focus frame as non-informative frame and an in-focus frame as informative frame. We propose a new technique to classify the video frames into two classes, informative and non-informative frames using a combination of Discrete Fourier Transform (DFT), Texture Analysis, and K-Means Clustering. The proposed technique can evaluate the frames without any reference image, and does not need any predefined threshold value. Our experimental studies indicate that it achieves over 96% of four different performance metrics (i.e. precision, sensitivity, specificity, and accuracy).
Cecilia Villarreal Montoya
Full Text Available El artículo resume la experiencia de intervención con una familia de la escuela de Villa Esperanza de Pavas. Se trata de un matrimonio con dificultades para disciplinar a sus tres hijos varones de ocho, seis, y cuatro años. En primer lugar, se exponen los principios teóricos y metodológicos, para luego mostrar la aplicación de ellos en el proceso vivido por la familia. Se aplica el modelo de intervención estructural, que busca que la misma familia logre realizar, paso a paso, los cambios requeridos en la dinámica y estructura familiar. En la situación específica de esta familia, se observa el fortalecimiento de la pareja como tal y como madre y padre en la medida que van logrando asumir la autoridad en forma compartida para disciplinar a los hijos. Al compartir esta experiencia, la autora pretende estimular a profesionales en Orientación a asumir el reto de considerar a las familias de la comunidad estudiantil, de las instituciones educativas donde laboran, como parte importante en el quehacer orientador.
María Gabriela Regueyra Edelman
Full Text Available Se comparte en este artículo la experiencia del uso de las TIC en dos cursos que se imparten en la carrera de Trabajo Social de la Universidad de Costa Rica. Se detallan los recursos tecnológicos utilizados y el uso que se da a cada uno: Facebook, Blogger, Moodle, correo electrónico, se complementa la experiencia con la incorporación de las opiniones de la población estudiantil matriculada en los cursos y destacando los retos que el uso de las TIC presenta a la población docentes en particular y a la Universidad de Costa Rica en general. El artículo retoma discusión de la Sociedad del Conocimiento y la Información, y las TIC como procesos que han transformado la sociedad actual, con su incorporación tanto en el campo económico, social y laboral como en los ámbitos educativo, familiar y personal, lo que ha generado nuevas interacciones sociales y una brecha entre la población que tiene acceso a la tecnología y la que no lo tiene, situación que ha impactado fundamentalmente el ámbito educativo, donde se han ido incorporando las TIC de manera progresiva, con algunas reservas tanto de la población docente como de la población estudiantil.
Luján-Sanchis, Marisol; Sanchis-Artero, Laura; Suárez-Callol, Patricia; Medina-Chuliá, Enrique
Capsule endoscopy currently plays a relevant role for Crohn´s disease. This manuscript will discuss the current indications and practical uses of capsule endoscopy in this disease. It is a non-invasive technique that represents a significant advance in the endoscopic diagnosis of small bowel conditions. These circumstances, together with its diagnostic yield and excellent tolerability, make it considerably acceptable by both patients and physicians. This paper discusses the current evidence on the specific circumstances where capsule endoscopy may be indicated for three specific scenarios: Suspected Crohn´s disease, indeterminate colitis, and established Crohn´s disease, where it plays an extensive role. Furthermore, the impact and implications of capsule endoscopy results for follow-up are reviewed. These recommendations must be interpreted and applied in the setting of the integral, individual management of these patients. Understanding its appropriate use in daily clinical practice and an analysis of results may define endoscopic scoring systems to assess activity and mucosal healing in this condition. The present role of capsule endoscopy for Crohn´s disease is subject to ongoing review, and appropriate usage uncovers novel applications likely to result in relevant changes for the future management of these patients.
Bondili Kohitha Bai
Full Text Available Wireless capsule endoscopy is a best option for exploring inaccessible areas of small intestine for inspection of gastrointestinal tract. This technique brings less pain compare to conventional endoscopy technique. The wireless endoscopy system comprises of three main modules: an ingestible capsule that is swallowed by the patient, an external control unit and display device for image display. In this paper we proposed pentagonal shape microstrip patch antenna for wireless capsule endoscopy system. Inhibiting characteristics of a single microstrip patch like low gain, light weight, thin thickness and smaller bandwidth, make it more popular. This kind of antenna is aggressive miniaturized to meet the requirements of the wireless capsule endoscope. The simulation results show that the designed Circular Polarization (CP pentagonal shaped microstrip patch antenna gives axial ratio of 0.6023 at 2.38 GHz and CP axial ratio bandwidth of 36MHz with 1.5%. The antenna designed for wireless capsule endoscopy is a proposed one, which may work effectively when compared to other antennas in the capsule.
Capsule endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of capsule endoscopy in patients suspected to have Crohn's disease. Capsule endoscopy allows for earlier diagnosis of Crohn's disease of the small bowel and improved diagnosis of colitis in patients where it is unclear if they suffer from Crohn's or ulcerative colitis. A test capsule is available to assess for small bowel strictures and thus avoid capsule retention. A common language has been developed and a new scoring index will be added to capsule software. It is envisioned that the manner in which we treat Crohn's disease in the future will change, based on earlier diagnosis and treatment aimed at mucosal healing rather than symptom improvement.
Waring, J Patrick; Baron, Todd H; Hirota, William K; Goldstein, Jay L; Jacobson, Brian C; Leighton, Jonathan A; Mallery, J Shawn; Faigel, Douglas O
This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.
Full Text Available We report a rare case of metastasis of hepatocellular carcinoma (HCC to the small bowel that presented as a pedunculated epithelial polyp. A 60-year-old man with liver cirrhosis type B was treated for HCC (stage IVb at our hospital. He had been admitted for melena and anemia. Capsule endoscopy was performed in this patient with obscure gastrointestinal bleeding. It showed a polypoid lesion with bleeding in the ileum. Double-balloon endoscopy was performed. The lesion was determined to be a pedunculated polyp in the ileum. Histological examination of biopsy specimens showed tumor cells resembling HCC. We performed endoscopic mucosal resection for the lesion by double-balloon endoscopy to prevent bleeding from the tumor. The patient had no melena or anemia and his condition improved after endoscopic mucosal resection. However, he died of liver failure 2 months later.
V. B. Surya Prasath
Full Text Available Video capsule endoscopy (VCE is used widely nowadays for visualizing the gastrointestinal (GI tract. Capsule endoscopy exams are prescribed usually as an additional monitoring mechanism and can help in identifying polyps, bleeding, etc. To analyze the large scale video data produced by VCE exams, automatic image processing, computer vision, and learning algorithms are required. Recently, automatic polyp detection algorithms have been proposed with various degrees of success. Though polyp detection in colonoscopy and other traditional endoscopy procedure based images is becoming a mature field, due to its unique imaging characteristics, detecting polyps automatically in VCE is a hard problem. We review different polyp detection approaches for VCE imagery and provide systematic analysis with challenges faced by standard image processing and computer vision methods.
Veitch, Andrew M; Uedo, Noriya; Yao, Kenshi; East, James E
Survival rates for upper gastrointestinal cancers are poor and oesophageal cancer incidence is increasing. Upper gastrointestinal cancer is also often missed during examinations; a predicament that has not yet been sufficiently addressed. Improvements in the detection of premalignant lesions, early oesophageal and gastric cancers will enable organ-preserving endoscopic therapy, potentially reducing the number of advanced upper gastrointestinal cancers and resulting in improved prognosis. Japan is a world leader in high-quality diagnostic upper gastrointestinal endoscopy and the clinical routine in this country differs substantially from Western practice. In this Perspectives article, we review lessons learnt from Japanese gastroscopy technique, training and screening for risk stratification. We suggest a key performance indicator for upper gastrointestinal endoscopy with a minimum total procedure time of 8 min, and examine how quality assurance concepts in bowel cancer screening in the UK could be applied to upper gastrointestinal endoscopy and improve clinical practice.
Sliker, Levin J; Ciuti, Gastone
Endoscopy dates back to the 1860s, but many of the most significant advancements have been made within the past decade. With the integration of robotics, the ability to precisely steer and advance traditional flexible endoscopes has been realized, reducing patient pain and improving clinician ergonomics. Additionally, wireless capsule endoscopy, a revolutionary alternative to traditional scopes, enables inspection of the digestive system with minimal discomfort for the patient or the need for sedation, mitigating some of the risks of flexible endoscopy. This review presents a research update on robotic endoscopic systems, including both flexible scope and capsule technologies, detailing actuation methods and therapeutic capabilities. A future perspective on endoscopic potential for screening, diagnostic and therapeutic gastrointestinal procedures is also presented.
Mahmud, Nadim; Cohen, Jonah; Tsourides, Kleovoulos; Berzin, Tyler M
Augmented reality (AR) is an environment-enhancing technology, widely applied in the computer sciences, which has only recently begun to permeate the medical field. Gastrointestinal endoscopy-which relies on the integration of high-definition video data with pathologic correlates-requires endoscopists to assimilate and process a tremendous amount of data in real time. We believe that AR is well positioned to provide computer-guided assistance with a wide variety of endoscopic applications, beginning with polyp detection. In this article, we review the principles of AR, describe its potential integration into an endoscopy set-up, and envisage a series of novel uses. With close collaboration between physicians and computer scientists, AR promises to contribute significant improvements to the field of endoscopy. © The Author(s) 2015. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.
Tarun Gupta; Mostafa Ibrahim; Jacques Deviere; André Van Gossum
AIM: To investigate the potential benefit of Fujinon intelligent chromo endoscopy (FICE)-assisted small bowel capsule endoscopy (SBCE) for detection and characterization of small bowel lesions in patients with obscure gastroenterology bleeding (OGIB).METHODS: The SBCE examinations (Pillcam SB2, Given Imaging Ltd) were retrospectively analyzed by two GI fellows (observers) with and without FICE enhancement. Randomization was such that a fellow did not assess the same examination with and without FICE enhancement. The senior consultant described findings as PO, PI and P2 lesions (non-pathological, intermediate bleed potential, high bleed potential), which were considered as reference findings. Main outcome measurements: Inter-observer correlation was calculated using kappa statistics. Sensitivity and specificity for P2 lesions was calculated for FICE and white light SBCE.RESULTS: In 60 patients, the intra-class kappa correlations between the observers and reference findings were 0.88 and 0.92 (P2), 0.61 and 0.79 (PI), for SBCE using FICE and white light, respectively. Overall 157 lesions were diagnosed using FICE as compared to 114 with white light SBCE (P = 0.15). For P2 lesions, the sensitivity was 94% vs 97% and specificity was 95% vs 96% for FICE and white light, respectively. Five (P2 lesions) out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE. Significantly more P0 lesions were diagnosed when FICE was used as compared to white light (39 vs 8, P < 0.001).CONCLUSION: FICE was not better than white light for diagnosing and characterizing significant lesions on SBCE for OGIB. FICE detected significantly more non-pathological lesions. Nevertheless, some vascular lesions could be more accurately characterized with FICE as compared to white light SBCE.
Full Text Available BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality highlight the need for endoscopy facilities to review the quality of the service they offer.
Sonomura, Tetsuo; Kishi, Kazushi; Ishii, Seigo; Kawai, Nobuyuki; Masuda, Mitsunori; Terada, Masaki; Nakamine, Hirokazu; Sato, Morio
A 73-year-old woman with a large esophagorespiratory fistula underwent bronchoscopy and computed tomographic (CT) virtual endoscopy before stenting. Noninvasive CT virtual endoscopy showed the large fistula, and the CT findings agreed with the bronchoscopic findings.
Rondonotti, E; Pennazio, M; Toth, E
BACKGROUND AND STUDY AIM: Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency...... findings. 55 patients underwent VCE as the third procedure after negative bidirectional endoscopy. The lesions were single in 89.5% of cases, and multiple in 10.5%. Retention of the capsule occurred in 9.8% of patients with small-bowel tumors. After VCE, 54/124 patients underwent 57 other examinations...
SC Sydney Chung
Full Text Available Whether a second-look endoscopy after initial endoscopic hemostasis is of value is controversial. Routine surveillance endoscopy on the next day and treatment of any remaining stigmata may provide marginal benefit, but existing studies are not large enough to demonstrate significant differences. Endoscopic retreatment when patients develop rebleeding may allow emergency surgery to be avoided if successful but may endanger life if further bleeding occurs. Early data indicate that surgery can be avoided in about 75% of patients by retreatment without an increase in mortality.
Héctor Julian Canaval-Zuleta
Full Text Available Despite a low incidence in developed countries, gastrointestinal taeniasis should be suspected in patients with abdominal pain, diarrhea, anemia, and/or malabsorption of unknown origin, even more so if they come from endemic regions or areas with poor hygienic and alimentary habits. Diagnosis is traditionally reached by identifying the parasite in stools, but more recently both serological and immunological approaches are also available. Based on a patient diagnosed by gastroscopy, a literature review was undertaken of patients diagnosed by endoscopy. We discuss endoscopy as diagnostic modality, and the effectiveness and safety that endoscopic treatment may provide in view of the potential risk for neurocysticercosis.
Full Text Available Yaron NivDepartment of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petah Tikva, IsraelAbstract: Crohn’s disease is a chronic inflammatory disorder affecting any part of the gastrointestinal tract, but frequently involves the small and large bowel. Typical presenting symptoms include abdominal pain and diarrhea. Patients with this disorder may also have extraintestinal manifestations, including arthritis, uveitis, and skin lesions. The PillCam™SB capsule is an ingestible disposable video camera that transmits high quality images of the small intestinal mucosa. This enables the small intestine to be readily accessible to physicians investigating for the presence of small bowel disorders, such as Crohn’s disease. Four meta-analyses have demonstrated that capsule endoscopy identifies Crohn’s disease when other methods are not helpful. It should be noted that it is the best noninvasive procedure for assessing mucosal status, but is not superior to ileocolonoscopy, which remains the gold standard for assessment of ileocolonic disease. Mucosal healing along the small bowel can only be demonstrated by an endoscopic procedure such as capsule endoscopy. Achievement of long-term mucosal healing has been associated with a trend towards a decreased need for hospitalization and a decreased requirement for corticosteroid treatment in patients with Crohn’s disease. Recently, we have developed and validated the Capsule Endoscopy Crohn’s Disease Activity Index (also known as the Niv score for Crohn’s disease of the small bowel. The next step is to expand our score to the colon, and to determine the role and benefit of a capsule endoscopy activity score in patients suffering from Crohn’s ileocolitis and/or colitis. This scoring system will also serve to improve our understanding of the impact of capsule endoscopy, and therefore treatment, on the immediate outcome of this disorder. As the best procedure available for assessing
Full Text Available BACKGROUND: Esophagogastroduodenoscopy (EGD is the most frequently performed diagnostic procedure for upper gastrointestinal disorders. The procedure is routinely performed under conscious sedation in North America. A significant proportion of morbidity and mortality associated with EGD is related to hypoxia due to conscious sedation. The use of sedation is also associated with an increase in cost, loss of work on the day of endoscopy and the need for the patient to be accompanied home after the procedure. Transnasal endoscopy has advantages such as no sedation and less patient monitoring, nursing time and expenses than conventional per oral EGD.
Canaval Zuleta, Héctor Julián; Company Campins, María M; Dolz Abadía, Carlos
Despite a low incidence in developed countries, gastrointestinal taeniasis should be suspected in patients with abdominal pain, diarrhea, anemia, and/or malabsorption of unknown origin, even more so if they come from endemic regions or areas with poor hygienic and alimentary habits. Diagnosis is traditionally reached by identifying the parasite in stools, but more recently both serological and immunological approaches are also available. Based on a patient diagnosed by gastroscopy, a literature review was undertaken of patients diagnosed by endoscopy. We discuss endoscopy as diagnostic modality, and the effectiveness and safety that endoscopic treatment may provide in view of the potential risk for neurocysticercosis.
Yagi, Kazuyoshi; Saka, Akiko; Nozawa, Yujiro; Nakamura, Atsuo
To reduce the incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer, Helicobacter pylori eradication therapy has been endorsed. It is not unusual for such patients to be H. pylori negative after eradication or for other reasons. If it were possible to predict H. pylori status using endoscopy alone, it would be very useful in clinical practice. To clarify the accuracy of endoscopic judgment of H. pylori status, we evaluated it in the stomach after endoscopic submucosal dissection (ESD) of gastric cancer. Fifty-six patients treated by ESD were enrolled. The diagnostic criteria for H. pylori status by conventional endoscopy and narrow-band imaging (NBI)-magnifying endoscopy were decided, and H. pylori status was judged by two endoscopists. Based on the H. pylori stool antigen test as a diagnostic gold standard, conventional endoscopy and NBI-magnifying endoscopy were compared for their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Interobserver agreement was assessed in terms of κ value. Interobserver agreement was moderate (0.56) for conventional endoscopy and substantial (0.77) for NBI-magnifying endoscopy. The sensitivity, specificity, PPV, and NPV were 0.79, 0.52, 0.70, and 0.63 for conventional endoscopy and 0.91, 0.83, 0.88, and 0.86 for NBI-magnifying endoscopy, respectively. Prediction of H. pylori status using NBI-magnifying endoscopy is practical, and interobserver agreement is substantial. © 2013 John Wiley & Sons Ltd.
ESTELA FERNÁNDEZ SABIOTE
Full Text Available Actualmente, la utilización de la marca como estrategia de diferenciación de la oferta parece adoptar una dimensión experiencial no tenida en cuenta hasta el momento en la literatura académica. El objetivo del presente trabajo es demostrar el interés que tiene para una empresa poseer una marca experiencial. De este modo, sobre la base del trabajo de Brakus, Schmitt y Zarantonello (2009, se adapta la escala desarrollada por estos autores a un contexto de consumo y marcas españolas. Para ello se recogieron, a través de un cuestionario, 278 observaciones de quince marcas pertenecientes a once categorías de producto. Los resultados muestran efectos positivos de la experiencia de marca sobre el capital de marca, la comunicación boca-oreja y la identificación marca-consumidor.
Gloria Luna Rodrigo
Full Text Available En este trabajo se estudia el uso que se hacia de las experiencias y relatos de viajes para enseaargeografia en la escuela primaria en Gran Bretaña al final del siglo XIX y el primer tercio del XX.Los relatos más importantes eran las aventuras de exploradores y viajeros narradas por ellos mismoso transcritas de sus diarios, series de historias que adaptaban las anteriores para niños pequeños,relatos de viaje de «geógrafos naturalistas» y .movelas geográñcasw. Se consideran libros de consultapara el profesor de los que extraer ideas y vividas imágenes de los fenómenos geográficos que iluminarancon datos llenos de color y concreción los áridos y abstractos hechos de índole científica.
Cardona Campuzano , Juliana; Robayo Bohórquez, Andrea Carolina
Divinamente será una Compañía, que iniciará operaciones en Bogotá en junio de 2016, especializada en la organización de eventos sociales de hasta 20 personas. Dentro de las categorías de servicios que ofrecerá, están la organización de eventos para dos personas, grupales o la asesoría en la planeación de estos. La propuesta de valor de la empresa se fundamenta en la creación de experiencias personalizadas e innovadoras para la celebración de ocasiones, en las cuales los clientes logren una co...
Mario Alejandro Molano
Full Text Available Desde finales del siglo XX, las investigaciones sobre modernidad, orientadas hacia distintos segmentos del campo cultural, han venido ganando un enorme terreno. Las obras de Walter Benjamin, leídas en esta perspectiva, cobran un gran valor. Se busca explorar cuatro temas benjaminianos: a algunos aspectos de su concepto de historia; b el concepto de experiencia, para mostrar su dimensión histórico-crítica con respecto al ascenso de la cultura moderna; c las afinidades entre el modo en que se desarrolla la visión alegórica en el drama barroco alemán y el modo en que Baudelaire afronta las problemáticas de la modernidad; d elementos de algunas formas culturales del arte moderno que entusiasman a Benjamin.
Evelyn Cerdas Agüero
Full Text Available El presente trabajo tiene como objetivo presentar experiencias y aprendizajes que han logrado algunos grupos de docentes con los que se ha trabajado por medio de talleres de juegos cooperativos para la paz. Los talleres se han facilitado desde la actividad de extensión Aula Activa: juegos cooperativos para la Educación para la Paz que se ha implementado en el Instituto de Estudios Latinoamericanos (IDELA desde el 2006. En este trabajo nos enfocamos en el trabajo con docentes del Ministerio de Educación Pública (MEP de Costa Rica, proceso que deja una serie de aprendizajes actitudinales, de valores, habilidades y cognocitivos.
Perucca A.,Ernesto; Iracheta,Alexis; Siebert,Alejandra; Espinoza,Rosemery; Bustamante, Rodrigo; Corvalán,Mónica; Estay,Ricardo
El presente trabajo muestra la experiencia clínica en el HBLT con la aplicación de la técnica de Minilap en la esterilización quirúrgica femenina. Se realizó un total de 118 esterilizaciones quirúrgicas, de las cuales 108 (91,5% del total de casos) fueron bajo anestesia local. En la gran mayoría de los casos (96,3%) resultó ser un método muy bien tolerado. Se presentaron sólo 2 casos de lesión vesical (1,7%) que se resolvieron sin inconvenientes y con una evolución favorable
European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy.
Dumonceau, J M; Riphaus, A; Aparicio, J R; Beilenhoff, U; Knape, J T A; Ortmann, M; Paspatis, G; Ponsioen, C Y; Racz, I; Schreiber, F; Vilmann, P; Wehrmann, T; Wientjes, C; Walder, B
Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this evidence- and consensus-based set of guideline is to provide non-anesthesiologists with a comprehensive framework for propofol sedation during digestive endoscopy. This guideline results from a collaborative effort from representatives of the European Society of Gastrointestinal Endoscopy (ESGE), the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) and the European Society of Anaesthesiology (ESA). These three societies have endorsed the present guideline.
Susana Beatriz Fernandes
Full Text Available Este artículo analiza y problematiza el proceso de producción de una investigación desarrollada con un grupo de niños en edad escolar, partiendo de la idea de experiencia desde lo punto de vista de Michel Foucault. Llama la atención sobre sus posibilidades y sus dificultades en el proceso, contraponiendo la perspectiva de una investigación-experiencia con la de una investigación-verdad. Discute los caminos de la investigación recorrido, sus particularidades y contingencias, dando énfasis la producción de lo corpus de la investigación y de sus análisis. Palabras-clave: experiencia, investigación-experiencia, investigación con niños, Foucault.
Suna, Nuretdin; Parlak, Erkan; Kuzu, Ufuk Baris; Yildiz, Hakan; Koksal, Aydin Seref; Oztas, Erkin; Sirtas, Zeliha; Yuksel, Mahmut; Aydinli, Onur; Bilge, Zulfikar; Taskiran, Ismail; Sasmaz, Nurgul
Abstract At present, we do not know the exact prevalence of Barrett esophagus (BE) developing later in patients without BE in their first endoscopic screening. The purpose of this study was to determine the prevalence of BE on the second endoscopic examination of patients who had no BE in their first endoscopic examination. The data of the patients older than 18 years who had undergone upper gastrointestinal system endoscopy more than once at the endoscopy unit of our clinic during the last 6 years were retrospectively analyzed. During the last 6 years, 44,936 patients had undergone at least one endoscopic examination. Among these patients, 2701 patients who had more than one endoscopic screening were included in the study. Of the patients, 1276 (47.3%) were females and 1425 (52.7%) were males, with an average age of 54.9 (18–94) years. BE was diagnosed in 18 (0.66%) of the patients who had no BE in the initial endoscopic examination. The patients with BE had reflux symptoms in their medical history and in both endoscopies, they revealed a higher prevalence of lower esophageal sphincter laxity, hiatal hernia, and reflux esophagitis when compared to patients without BE (P < 0.001). Our study showed that in patients receiving no diagnosis of BE on their first endoscopic examination performed for any reason, the prevalence of BE on their second endoscopy within 6 years was very low (0.66%). PMID:27057907
Kong, Xiao-feng; Li, Ying; Li, Hao-min; Lu, Xu-dong
This paper presents a method based on NLP to realize structuralization of digestive endoscopy reports. The method is taking advantage of existing NLP's processing technologies and introducing minimal standard terminology (MST) to transform a narrative gastroscopy report into the structuralization report based on MST, whose accuracy rate is 92.3%.
Imdadur Rahman; Praful Patel; Philip Boger; Shahnawaz Rasheed; Mike Thomson; Nadeem Ahmad Afzal
Since the first report of use of endoscopy in childrenin the 1970s, there has seen an exponential growthin published experience and innovation in the field. Inthis review article we focus on modern age therapeuticendoscopy practice, explaining use of traditional aswell as new and innovative techniques, for diagnosisand treatment of diseases in the paediatric uppergastrointestinal tract.
Conclusion: Sleep endoscopy is a useful tool for the assessment of level, degree and shape of the upper airway obstruction during sleep in OSAS and this could be helpful in preoperative evaluation. Presence of obstruction at hypopharyngeal level or tongue base obstruction is an indicator of OSAS severity.
Propofol sedation by nonanesthesiologists is still a highly controversial issue despite the fact that numerous studies have approved this sedation regimen for gastrointestinal endoscopy. A new position statement from a collaboration of four different American gastroenterology and hepatology societies outlines the latest recommendations for nonanesthesiologist administration of propofol.
Charalampos Pilichos; Emmanouil Bobotis
Colonic diverticulosis is one of the most common causes of lower gastrointestinal bleeding. Endoscopy is not only a useful diagnostic tool for localizing the bleeding site, but also a therapeutic modality for its management. To date, haemostatic methods have included adrenaline injection, mechanical clipping, thermal and electrical coagulation or combinations of them. The results of all published data are herein reviewed.
Shigematsu, Y.; Korogi, Y.; Hirai, T. [Kumamoto Univ. (Japan). Dept. of Radiology; Okuda, T.; Ikushima, I.; Sugahara, T.; Liang, L.; Ge, Y.; Takahashi, M.
We used constructive interference in steady state (CISS) 3D Fourier transform (3DFT) MRI data sets to obtain three-dimensional (3D) virtual MRI endoscopic views of the intracranial cerebrospinal fluid (CSF) spaces, processing them with a commercially available perspective endoscopic algorithm. We investigated the potential of the intracranial virtual MRI endoscopy applied to visualisation of the pathology in 13 patients with surgically confirmed trigeminal neuralgia (3), hemifacial spasm (3), acoustic neuroma (3), suprasellar germinoma (1), Langerhans cell histiocytosis (1), lateral ventricle nodules (1) and pituitary dwarfism (1). All images were acquired using a 1.5-T imager employing a circular polarised head coil. The CISS-3DFT data sets were transferred to a workstation for processing with the perspective endoscopic algorithm. Postprocessing for virtual MRI endoscopy was possible for all data sets. The lesions in 12 patients, and their complex anatomical relationships with the surrounding structures, were well seen on the 3D images. A small acoustic neuroma in the internal auditory meatus was not seen using virtual endoscopy. Although virtual MRI endoscopy has limitations, it provides 3D images which cannot be acquired using any other procedure. (orig.) With 6 figs., 16 refs.
Westerhof, J.; Weersma, R. K.; Koornstra, J. J.
The possibility to visualise the small bowel has dramatically improved with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). CE and DBE have become standard practice in investigating suspected diseases of the small bowel. An important reason to perform small bowel inv
Westerhof, Jessie; Weersma, Rinse K.; Koornstra, Jan J.
Background: In 20% to 30% of capsule endoscopy (CE) procedures, the capsule does not reach the cecum within recording time, with incomplete imaging of the small bowel, which limits the value of CE. Objective: To identify possible risk factors for incomplete small-bowel CE examinations. Design: Data
Westerhof, J.; Weersma, R. K.; Koornstra, J. J.
The possibility to visualise the small bowel has dramatically improved with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). CE and DBE have become standard practice in investigating suspected diseases of the small bowel. An important reason to perform small bowel
Hardesty, Douglas A; Ponce, Francisco A; Little, Andrew S; Nakaji, Peter
Objectives Skull base endoscopy allows for minimal access approaches to the sinonasal contents and cranial base. Advances in endoscopic technique and applications have been published rapidly in recent decades. Setting We utilized an Internet-based scholarly database (Web of Science, Thomson Reuters) to query broad-based phrases regarding skull base endoscopy literature. Participants All skull base endoscopy publications. Main Outcome Measures Standard bibliometrics outcomes. Results We identified 4,082 relevant skull base endoscopy English-language articles published between 1973 and 2014. The 50 top-cited publications (n = 51, due to articles with equal citation counts) ranged in citation count from 397 to 88. Most of the articles were clinical case series or technique descriptions. Most (96% [49/51])were published in journals specific to either neurosurgery or otolaryngology. Conclusions A relatively small number of institutions and individuals have published a large amount of the literature. Most of the publications consisted of case series and technical advances, with a lack of randomized trials.
Minoli, Giorgio; Borsato, Paolo; Colombo, Enrico; Bortoli, Aurora; Casetti, Tino; de Pretis, Giovanni; Ferraris, Luca; Lorenzini, Ivano; Meggio, Alberto; Meroni, Rudy; Piazzi, Lucia; Terruzzi, Vittorio
Not much is known about errors and near misses in digestive endoscopy. To verify whether an incident report, with certain facilitating features, gives useful information about unintended events, only excluding errors in medical diagnosis. Nine endoscopy units took part in this cross sectional, prospective, multicentre study which lasted for two weeks. Members of the staff were required to report any unintended, potentially dangerous event observed during the daily work. A form was provided with a list of "reminders" and facilitators were appointed to help. The main outcome measurements were type of event, causes, corrective interventions, stage of occurrence in the workflow and qualification of the reporters. A total of 232 errors were reported (two were not related to endoscopy). The remaining 230 amount to 10.3% of 2239 procedures; 66 (29%) were considered errors with consequences, 164 (71%) "near misses". There were 150 pre-operative errors (65%), 22 operative (10%) and 58 post-operative (25%). Corrective interventions were provided for 60 cases of errors and 119 near misses. Most of the events were reported by the nurses (106 out of 232, 46%). Short-term incident reporting focusing on near misses, using forms with lists of "reminders", and the help of a facilitator, can give useful information on errors and near misses in digestive endoscopy. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Mid-gastrointestinal bleeding is defined as a bleeding of the small bowel and is the most common indication for small bowel endoscopy. Intraoperative enteroscopy has been regarded as gold standard for a long time. With the introduction of different endoscopy techniques, they play now the central role, whereas intraoperative enteroscopy has become a reserve method for selected patients. Actually, there are, beside capsule endoscopy, five non-surgical, flexible enteroscopy techniques available. In Germany and Europe balloon-assisted enteroscopy (double balloon and single balloon enteroscopy) is mainly used. Double balloon enteroscopy (DBE) is the "oldest" flexible enteroscopy technique and has become established throughout the world for diagnostic and therapeutic examinations of the small bowel. The majority of the studies have been performed with DBE and it provides the highest rate of complete enteroscopy. Nevertheless, technical improvements to make enteroscopy easier and faster are still required. In patients with chronic MGI or problematic situations capsule endoscopy is an ideal screening option. In case of acute MGI the flexible enteroscopy techniques should be preferred because of the high diagnostic yield combined with the possibility of endoscopic therapeutic interventions. In difficult cases with unsuccessful enteroscopy, CT angiography and conventional angiography with the option of embolisation had proved their value.
David Silva Barrera; Yanicet Aveleira Rodríguez
El artículo aborda la situación actual del diseño de experiencia de usuarios para los sistemas informáticos. Refleja la necesidad de encontrar una solución favorable para los usuarios. Propone entonces el montaje de un laboratorio de diseño de experiencia de usuario que brinde servicios en la empresa. La propuesta incluye la descripción de los elementos que deben incorporarse en el laboratorio.
Para una primera etapa de recogida de información, sobre los alumnos que participaron en las experiencias, se utilizaron diferentes pruebas analizadas en descripción de la experiencia, y teniendo como base dichas pruebas y el conocimiento de los profesores que impartieron clases, fueron seleccionados los diferentes grupos experimentales los que aprenderían los temas a través de los programas tutoriales.
H Miller MacSween
Full Text Available The purpose of this statement is to provide guidelines to assist hospital credentialling committees in their task of granting privileges to perform gastrointestinal endoscopy. Endoscopy of the gastrointestinal tract has evolved over the past 30 years as a potent tool to assist in the evaluation, diagnosis and therapy of patients with gastrointestinal tract disorders. Although gastrointestinal endoscopy was initially developed as a purely diagnostic tool, the development of therapeutic endoscopic techniques has dramatically expanded the role of gastrointestinal endoscopy, frequently to a therapeutic one. In setting guidelines for training and credentialling one must recognize that, excluding flexible sigmoidoscopy, endoscopists should be well trained in therapeutic endoscopy.
You-hong FANG; Chun-xiao CHEN; Bing-ling ZHANG
Background: Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition ofsimethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators. Methods: Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and sime-thicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded. Results: Simethicone significantly reduced luminal bubbles both in the proximal and distal small intes-tines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003). Conclusion: Bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.
Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate,endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn's disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions).The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming,can overcome some limitations of capsule endoscopy.At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).
EXPERIENCIAS EXTRASENSORIALES Y EXPERIENCIAS ALUCINATORIAS: EXAMINANDO LA HIPÓTESIS DEL CONTINUO DE EXPERIENCIAS ESQUIZOTÍPICAS/ EXTRASENSORIAL AND HALLUCINATORY EXPERIENCES: EXAMINING THE CONTINUOUS THEORY ON SCHIZOTYPAL EXPERIENCES
RESUMENUna experiencia extrasensorial es aquella en la que parece que la mente de una persona ha adquirido la informaciónremota, es decir, aparentemente sin la mediación de los sentidos humanos conocidos o procesos de inferencia lógica. Portanto, lo «extrasensorial» en la experiencia extrasensorial corresponde a juzgar por las apariencias y no necesariamente a larealidad, mientras que lo «extrasensorial» en la percepcion extrasensorial se refiere a la naturaleza de una presunta realidadparano...
En este artículo se analizan las posibles contribuciones de la experiencia profesional empresarial para el ámbito académico. Expone algunas oportunidades y prácticas de gestión que, sin afectar la misión y la razón de ser de la Universidad, pueden trasladarse del modelo empresarial a las diferentes funciones y roles que desempeña la Universidad, y contribuir con una gestión más eficiente y eficaz de los recursos disponibles en beneficio de la generación y transferencia del conocimiento, y del...
European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anaesthesiologist administration of propofol for GI endoscopy.
Dumonceau, J M; Riphaus, A; Aparicio, J R; Beilenhoff, U; Knape, J T A; Ortmann, M; Paspatis, G; Ponsioen, C Y; Racz, I; Schreiber, F; Vilmann, P; Wehrmann, T; Wientjes, C; Walder, B
Propofol sedation by non-anaesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this evidence- and consensus-based set of guideline is to provide non-anaesthesiologists with a comprehensive framework for propofol sedation during digestive endoscopy. This guideline results from a collaborative effort from representatives of the European Society of Gastrointestinal Endoscopy (ESGE), the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) and the European Society of Anaesthesiology (ESA). These three societies have endorsed the present guideline.The guideline is published simultaneously in the Journals Endoscopy and European Journal of Anaesthesiology.
Jorge F. Coronel
Full Text Available En este trabajo se relacionó la práctica experimental de laboratorio co n el análisis de problemas ambientales. El objetivo de este trabajo es analizar una propuesta que vinculó el trabajo experimental con la situación del ambiente local para promover el cuidado de la naturaleza y su uso con sostenibilidad . Esta estrategia brindó un enfoque integrador aportando a los alumnos de profesorado una alternativa de aprendizaje con exper iencias sencillas para el estudio cualitativo de l ambiente local y motivar a l análisis de problemas asociad o s. Las experiencias permitieron caracterizar las muestras de suelo, agua y aire del lugar de residencia de los alumnos. La información experimental obtenida potenció la discusión de la situación ambiental actual. E l enfoque de enseñanza basado en problemas socio - científicos posibilit ó la visión interdisciplinar del tema , redimensionando valores y acciones para el cuidado ambiental y el desarrollo sustentable.
Full Text Available Los ordenadores-tablet están acaparando toda la atención en estos momentos y forman parte de nuestra vida cotidiana. Por ello, no es de extrañar que en el ámbito educativo se hayan arbitrado fórmulas para incorporarlos en las aulas. La presente investigación pretende mostrar las estrategias llevadas a cabo en determinadas experiencias con iPads en escuelas primarias austriacas. Por un lado, se describe el desarrollo de las aplicaciones (apps educativas apropiadas para su empleo en aulas. Y por otro, cada lección apoyada en las tecnologías es analizada y evaluada desde una perspectiva técnica. Las aportaciones más representativas de la investigación evidencian las diversas fórmulas de utilización de este tipo de ordenadores para promover una influencia positiva en la enseñanza, también se apuntan recomendaciones prácticas sobre cómo deberían ser usados en aulas.
Maria Jesus Monteagudo
Full Text Available El presente artículo aborda desde una perspectiva actual el tema de los Beneficios del Ocio, uno de los conceptos esenciales en el estudio del ocio como factor de desarrollo personal y social. Se aporta una visión evolutiva del concepto a través de diferentes corrientes teóricas, subrayando la importancia de los beneficios del ocio entendidos desde una acepción: como mejora de una condición o situación de una persona, grupo o entidad, como prevención y/o mantenimiento y finalmente, como consecución de una experiencia psicológica satisfactoria en el marco de un ocio ajustado. Desde la perspectiva de la autora, el ocio promueve la consecución de dos tipos de beneficios, intermedios y finales, que contribuyen a mejorar el bienestar y la calidad de vida de los ciudadanos. Los profesionales del ocio procedentes tanto del sector público como del privado deberían tomar conciencia de los beneficios que pueden promoverse a través del ocio e incorporar estos conocimientos en el diseño de políticas, estrategias de gestión y modelos de intervención en ocio
Hilda Evelia Prías-Vanegas
Full Text Available Objetivo: describir e interpretar las experiencias relacionadas con los sentimientos e ideas experimentados por las adolescentes al conocer su estado de embarazo. Método: se trabajó con un grupo de 22 adolescentes de instituciones públicas de I nivel de salud de Sincelejo, Colombia. El estudio, realizado en 2005, se abordó desde un enfoque cualitativo, con información recogida en entrevistas personales, grabadas con consentimiento de las jóvenes. Resultados: el embarazo genera en la adolescente sentimientos de displacer relacionados con miedo, tristeza, dolor, sufrimiento, culpa, vergüenza y decepción, acompañados de ideas de negación, evasión, duda, arrepentimiento y deseos de abortar, los cuales no aparecen cuando la adolescente cuenta con el apoyo de su compañero sentimental o el de sus padres. Conclusión: las adolescentes necesitan apoyo, comprensión y ayuda, dado que están más sensibles, lábiles, inseguras y con baja autoestima, situación que requiere que el equipo de salud desarrolle y muestre competencias en el área humanística, acercamiento personal, empatía y trato humanizado e individualizado en la atención de la población de adolescentes embarazadas.
YU Lian-zhi; YAN Guo-zheng; MA Guan-ying; ZAN Peng
The development of active endoscopy techniques is one important area of medical robot. This paper designed a new flexible and active endoscopy robotic system for direct tracheal inspection. The mobile mechanism of the robot is based on the inchworm movement actuated by pneumatic rubber actuator. There are five air chambers controlled independently, by adjusting pressures in air chambers, the robot can move in a straight mode or in a bending mode. The inspection sensors and some therapy surgery tools can be equipped in the front of the robot.The prototype was made and its mechanical characteristics were analyzed. The robot could move smoothly in a small plastic tube, and the robot is respectable to be used for inspection in human trachea directly.
Mahmud, Nadim; Cohen, Jonah; Tsourides, Kleovoulos; Berzin, Tyler M.
Augmented reality (AR) is an environment-enhancing technology, widely applied in the computer sciences, which has only recently begun to permeate the medical field. Gastrointestinal endoscopy—which relies on the integration of high-definition video data with pathologic correlates—requires endoscopists to assimilate and process a tremendous amount of data in real time. We believe that AR is well positioned to provide computer-guided assistance with a wide variety of endoscopic applications, beginning with polyp detection. In this article, we review the principles of AR, describe its potential integration into an endoscopy set-up, and envisage a series of novel uses. With close collaboration between physicians and computer scientists, AR promises to contribute significant improvements to the field of endoscopy. PMID:26133175
Full Text Available Wireless capsule endoscopy (WCE offers a feasible noninvasive way to detect the whole gastrointestinal (GI tract and revolutionizes the diagnosis technology. However, compared with wired endoscopies, the limited working time, the low frame rate, and the low image resolution limit the wider application. The progress of this new technology is reviewed in this paper, and the evolution tendencies are analyzed to be high image resolution, high frame rate, and long working time. Unfortunately, the power supply of capsule endoscope (CE is the bottleneck. Wireless power transmission (WPT is the promising solution to this problem, but is also the technical challenge. Active CE is another tendency and will be the next geneion of the WCE. Nevertheless, it will not come true shortly, unless the practical locomotion mechanism of the active CE in GI tract is achieved. The locomotion mechanism is the other technical challenge, besides the challenge of WPT. The progress about the WPT and the active capsule technology is reviewed.
Yeung, Baldwin Po Man; Chiu, Philip Wai Yan
Multiple robotic flexible endoscope platforms have been developed based on cross specialty collaboration between engineers and medical doctors. However, significant number of these platforms have been developed for the natural orifice transluminal endoscopic surgery paradigm. Increasing amount of evidence suggest the focus of development should be placed on advanced endolumenal procedures such as endoscopic submucosal dissection instead. A thorough literature analysis was performed to assess the current status of robotic flexible endoscopic platforms designed for advanced endolumenal procedures. Current efforts are mainly focused on robotic locomotion and robotic instrument control. In the future, advances in actuation and servoing technology, optical analysis, augmented reality and wireless power transmission technology will no doubt further advance the field of robotic endoscopy. Globally, health systems have become increasingly budget conscious; widespread acceptance of robotic endoscopy will depend on careful design to ensure its delivery of a cost effective service.
Turan, Mehmet Nuri; Aslan, Mehmet; Bolukbas, Filiz Fusun; Bolukbas, Cengiz; Selek, Sahbettin; Sabuncu, Tevfik
Some authors have investigated the effects of oxidative stress in some process such as undergoing laparoscopic. However, the effect of upper gastrointestinal system endoscopy process on oxidative stress is unclear. We evaluated the short-term effect of upper gastrointestinal system endoscopy process on oxidative stress. Thirty patients who underwent endoscopy process and 20 healthy controls were enrolled in the prospective study. Serum total antioxidant capacity and total oxidant status measurements were measured before and after endoscopy process. The ratio percentage of total oxidant status to total antioxidant capacity was regarded as oxidative stress index. Before endoscopy process, serum total antioxidant capacity levels were higher, while serum total oxidant status levels and oxidative stress index values were lower in patients than controls, but this difference was not statistically significant (all, p > 0.05). After endoscopy process, serum total antioxidant capacity and total oxidant status levels were significantly higher in patients than before endoscopy process (both, p oxidative stress index values were slight higher in patients but this difference was not statistically significant (p > 0.05). We observed that serum TAC and TOS levels were increased in patients who underwent endoscopy process after endoscopy process. However, short-time upper gastrointestinal system endoscopy process did not cause an important change in the oxidative stress index. Further studies enrolling a larger number of patients are required to clarify the results obtained here.
Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients. Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control gr...
Lee, Hee Seung; Jang, Jong Soon; Lee, Seungho; Yeon, Myeong Ho; Kim, Ki Bae; Park, Jae Geun; Lee, Joo Young; Kim, Mi Jin; HAN, JOUNG-HO; Sung, Rohyun; Park, Seon Mee
Background/Aims Ampullary tumors come in a wide variety of malignant forms. We evaluated the diagnostic accuracy of endoscopy for ampullary tumors, and analyzed the causes of misdiagnosis. Methods We compared endoscopic imaging and biopsy results to final diagnoses. Types of endoscope, numbers of biopsy specimens taken, and final diagnoses were evaluated as possible factors influencing diagnostic accuracy. Results Final diagnoses were 19 adenocarcinomas, 18 normal or papillitis, 11 adenomas, ...
Fernandez-Urien, Ignacio; Panter, Simon; Carretero, Cristina; Davison, Carolyn; Dray, Xavier; Fedorov, Evgeny; Makins, Richard; Mascarenhas, Miguel; McAlindon, Mark; McNamara, Deirdre; Palmer, Hansa; Rey, Jean Francoise; Saurin, Jean Christophe; Seitz, Uwe; Spada, Cristiano; Toth, Ervin; Wiedbrauck, Felix; Keuchel, Martin
Capsule endoscopy (CE) has become a first-line noninvasive tool for visualisation of the small bowel (SB) and is being increasingly used for investigation of the colon. The European Society of Gastrointestinal Endoscopy (ESGE) guidelines have specified requirements for the clinical applications of CE. However, there are no standardized recommendations yet for CE training courses in Europe. The following suggestions in this curriculum are based on the experience of European CE training courses directors. It is suggested that 12 hours be dedicated for either a small bowel capsule endoscopy (SBCE) or a colon capsule endoscopy (CCE) course with 4 hours for an introductory CCE course delivered in conjunction with SBCE courses. SBCE courses should include state-of-the-art lectures on indications, contraindications, complications, patient management and hardware and software use. Procedural issues require approximately 2 hours. For CCE courses 2.5 hours for theoretical lessons and 3.5 hours for procedural issued are considered appropriate. Hands-on training on reading and interpretation of CE cases using a personal computer (PC) for 1 or 2 delegates is recommended for both SBCE and CCE courses. A total of 6 hours hands-on session- time should be allocated. Cases in a SBCE course should cover SB bleeding, inflammatory bowel diseases (IBD), tumors and variants of normal and cases with various types of polyps covered in CCE courses. Standardization of the description of findings and generation of high-quality reports should be essential parts of the training. Courses should be followed by an assessment of trainees' skills in order to certify readers' competency.
Harris, Zachary P; Liu, Julia; Saltzman, John R
Recent development and expansion of endoscopy units has necessitated similar progress in the quality assurance of procedure sedation and monitoring. The large number of endoscopic procedures performed annually underlies the need for standardized quality initiatives focused on mitigating patient risk before, during, and immediately after endoscopic sedation, as well as improving procedure outcomes and patient satisfaction. Specific standards are needed for newer sedation modalities, including propofol administration. This article reviews the current guidelines and literature concerning quality assurance and endoscopic procedure sedation.
Alexander F. Hagel
Full Text Available Introduction. Gastrointestinal bleeding represents the main indication for emergency endoscopy (EE. Lately, several hemostatic powders have been released to facilitate EE. Methods. We evaluated all EE in which Hemospray was used as primary or salvage therapy, with regard to short- and long-term hemostasis and complications. Results. We conducted 677 EE in 474 patients (488 examinations in 344 patients were upper GI endoscopies. Hemospray was applied during 35 examinations in 27 patients (19 males, 33 during upper and 2 during lower endoscopy. It was used after previous treatment in 21 examinations (60% and in 14 (40% as salvage therapy. Short-term success was reached in 34 of 35 applications (97.1%, while long-term success occurred in 23 applications (65.7%. Similar long-term results were found after primary application (64,3% or salvage therapy (66,7%. Rebleeding was found in malignant and extended ulcers. One major adverse event (2.8% occurred with gastric perforation after Hemospray application. Discussion. Hemospray achieved short-term hemostasis in virtually all cases. The long-term effect is mainly determined by the type of bleeding source, but not whether it was applied as first line or salvage therapy. But, even in the failures, patients had benefit from hemodynamic stabilization and consecutive interventions in optimized conditions.
Fu, L; Gu, M
Nonlinear optical microscopy has been an indispensable laboratory tool of high-resolution imaging in thick tissue and live animals. Rapid developments of fibre-optic components in terms of growing functionality and decreasing size provide enormous opportunities for innovations in nonlinear optical microscopy. Fibre-based nonlinear optical endoscopy is the sole instrumentation to permit the cellular imaging within hollow tissue tracts or solid organs that are inaccessible to a conventional optical microscope. This article reviews the current development of fibre-optic nonlinear optical microscopy and endoscopy, which includes crucial technologies for miniaturized nonlinear optical microscopy and their embodiments of endoscopic systems. A particular attention is given to several classes of photonic crystal fibres that have been applied to nonlinear optical microscopy due to their unique properties for ultrashort pulse delivery and signal collection. Furthermore, fibre-optic nonlinear optical imaging systems can be classified into portable microscopes suitable for imaging behaving animals, rigid endoscopes that allow for deep tissue imaging with minimally invasive manners, and flexible endoscopes enabling imaging of internal organs. Fibre-optic nonlinear optical endoscopy is coming of age and a paradigm shift leading to optical microscope tools for early cancer detection and minimally invasive surgery.
Full Text Available Aim: We analyzed the results of upper gastrointestinal endoscopy performed between November 2011 and January 2013 in the endoscopy unit at Bayburt State Hospital. Methods: Endoscopic analyses were done with a PENTAX EPK 100P equipment. The results were assessed retrospectively. Results: A total of 1008 patients (664 women, 344 men aged between 17 and 88 (mean: 50±18 years have undergone upper gastrointestinal endoscopy. 186 (18.4% patients were diagnosed with pangastritis, 81 - with esophagitis (8%, 68 - with antral gastritis (6.7%, 67 - with duodenal ulcer (6.6%, 57 - with gastric ulcer (5.6%, 35 - with alkaline reflux gastritis (3.6%, 21 - with duodenitis (2.1%, 5 - with gastric cancer (0.5%, 4 - with esophagial cancer (0.4%, 4 - with gastric polyp (0.4% and 3 patients were diagnosed with esophagial ulcer (0.3%. Conclusion: Lesions were most commonly observed in the stomach. Gastritis, esophagitis, duodenal and gastric ulcer were frequently observed in our city. (The Medical Bulletin of Haseki 2013; 51: 116-9
Ferreira, Alexandre Oliveira; Cravo, Marília
Gastrointestinal endoscopies are invasive and unpleasant procedures that are increasingly being used worldwide. The importance of high quality procedures (especially in colorectal cancer screening), the increasing patient awareness and the expectation of painless examination, increase the need for procedural sedation. The best single sedation agent for endoscopy is propofol which, due to its' pharmacokinetic/dynamic profile allows for a higher patient satisfaction and procedural quality and lower induction and recovery times, while maintaining the safety of traditional sedation. Propofol is an anesthetic agent when used in higher doses than those needed for endoscopy. Because of this important feature it may lead to cardiovascular and respiratory depression and, ultimately, to cardiac arrest and death. Fueled by this argument, concern over the safety of its administration by personnel without general anesthesia training has arisen. Propofol usage seems to be increasing but it's still underused. It is a safe alternative for simple endoscopic procedures in low risk patients even if administered by non-anesthesiologists. Evidence on propofol safety in complex procedures and high risk patients is less robust and in these cases, the presence of an anesthetist should be considered. We review the existing evidence on the topic and evaluate the regional differences on sedation practices.
Albrecht, Heinz; Nägel, Andreas; Vitali, Francesco; Vetter, Marcel; Dauth, Christine; Neurath, Markus F.; Raithel, Martin
Introduction. Gastrointestinal bleeding represents the main indication for emergency endoscopy (EE). Lately, several hemostatic powders have been released to facilitate EE. Methods. We evaluated all EE in which Hemospray was used as primary or salvage therapy, with regard to short- and long-term hemostasis and complications. Results. We conducted 677 EE in 474 patients (488 examinations in 344 patients were upper GI endoscopies). Hemospray was applied during 35 examinations in 27 patients (19 males), 33 during upper and 2 during lower endoscopy. It was used after previous treatment in 21 examinations (60%) and in 14 (40%) as salvage therapy. Short-term success was reached in 34 of 35 applications (97.1%), while long-term success occurred in 23 applications (65.7%). Similar long-term results were found after primary application (64,3%) or salvage therapy (66,7%). Rebleeding was found in malignant and extended ulcers. One major adverse event (2.8%) occurred with gastric perforation after Hemospray application. Discussion. Hemospray achieved short-term hemostasis in virtually all cases. The long-term effect is mainly determined by the type of bleeding source, but not whether it was applied as first line or salvage therapy. But, even in the failures, patients had benefit from hemodynamic stabilization and consecutive interventions in optimized conditions. PMID:28232848
Regeling, Bianca; Thies, Boris; Gerstner, Andreas O. H.; Westermann, Stephan; Müller, Nina A.; Bendix, Jörg; Laffers, Wiebke
Hyperspectral imaging (HSI) is increasingly gaining acceptance in the medical field. Up until now, HSI has been used in conjunction with rigid endoscopy to detect cancer in vivo. The logical next step is to pair HSI with flexible endoscopy, since it improves access to hard-to-reach areas. While the flexible endoscope’s fiber optic cables provide the advantage of flexibility, they also introduce an interfering honeycomb-like pattern onto images. Due to the substantial impact this pattern has on locating cancerous tissue, it must be removed before the HS data can be further processed. Thereby, the loss of information is to minimize avoiding the suppression of small-area variations of pixel values. We have developed a system that uses flexible endoscopy to record HS cubes of the larynx and designed a special filtering technique to remove the honeycomb-like pattern with minimal loss of information. We have confirmed its feasibility by comparing it to conventional filtering techniques using an objective metric and by applying unsupervised and supervised classifications to raw and pre-processed HS cubes. Compared to conventional techniques, our method successfully removes the honeycomb-like pattern and considerably improves classification performance, while preserving image details. PMID:27529255
Hwang, Sae; Oh, JungHwan; Cox, Jay; Tang, Shou Jiang; Tibbals, Harry F.
Wireless Capsule Endoscopy (WCE) is a relatively new technology (FDA approved in 2002) allowing doctors to view most of the small intestine. Other endoscopies such as colonoscopy, upper gastrointestinal endoscopy, push enteroscopy, and intraoperative enteroscopy could be used to visualize up to the stomach, duodenum, colon, and terminal ileum, but there existed no method to view most of the small intestine without surgery. With the miniaturization of wireless and camera technologies came the ability to view the entire gestational track with little effort. A tiny disposable video capsule is swallowed, transmitting two images per second to a small data receiver worn by the patient on a belt. During an approximately 8-hour course, over 55,000 images are recorded to a worn device and then downloaded to a computer for later examination. Typically, a medical clinician spends more than two hours to analyze a WCE video. Research has been attempted to automatically find abnormal regions (especially bleeding) to reduce the time needed to analyze the videos. The manufacturers also provide the software tool to detect the bleeding called Suspected Blood Indicator (SBI), but its accuracy is not high enough to replace human examination. It was reported that the sensitivity and the specificity of SBI were about 72% and 85%, respectively. To address this problem, we propose a technique to detect the bleeding regions automatically utilizing the Expectation Maximization (EM) clustering algorithm. Our experimental results indicate that the proposed bleeding detection method achieves 92% and 98% of sensitivity and specificity, respectively.
Full Text Available 【Abstract】Objective: To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treat-ing these patients by minimally invasive surgery. Methods: Over the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. Other 30 patients treated by routine bilateral approaches within the same period were taken as control. Results: Seventeen cases (54.8% in the unilateral operation group survived and were in good condition, 8 (25.8% had moderate disability, 4 (12.9% had severe disability, 1 (3.2% was in vegetative state, and 1 (3.2% died. Compared with the control group, the Glasgow Out-come Scale score was not significantly different in the uni-lateral operation group, but the operation time, blood trans-fusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group. Conclusions: Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dis-symmetric bilateral frontal contusion. It can obviously di-minish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation. Key words: Brain injuries; Intracranial hemorrage, traumatic; Endoscopy; Surgically procedures, minimally invasive
Full Text Available Hyperspectral imaging (HSI is increasingly gaining acceptance in the medical field. Up until now, HSI has been used in conjunction with rigid endoscopy to detect cancer in vivo. The logical next step is to pair HSI with flexible endoscopy, since it improves access to hard-to-reach areas. While the flexible endoscope’s fiber optic cables provide the advantage of flexibility, they also introduce an interfering honeycomb-like pattern onto images. Due to the substantial impact this pattern has on locating cancerous tissue, it must be removed before the HS data can be further processed. Thereby, the loss of information is to minimize avoiding the suppression of small-area variations of pixel values. We have developed a system that uses flexible endoscopy to record HS cubes of the larynx and designed a special filtering technique to remove the honeycomb-like pattern with minimal loss of information. We have confirmed its feasibility by comparing it to conventional filtering techniques using an objective metric and by applying unsupervised and supervised classifications to raw and pre-processed HS cubes. Compared to conventional techniques, our method successfully removes the honeycomb-like pattern and considerably improves classification performance, while preserving image details.
Joaquín MORENO MARCHAL
Full Text Available La creatividad y la innovación se han convertido en recursos clave en la denominada sociedad del conocimiento, que bien podría ser también llamada sociedad de la innovación. Pero innovar es una actividad compleja, que integra la aplicación de múltiples capacidades, el pensamiento divergente y convergente, la gestión de equipos humanos, la comunicación. Ahora bien, a innovar se puede, y se debe, aprender. Aprender a innovar es un reto y también una obligación para el conjunto del sistema educativo en todos sus niveles. Partiendo de estas consideraciones este trabajo expone una experiencia de aprendizaje de la creatividad y de la innovación a través de un curso totalmente on line basado en la plataforma MOODLE, en el marco del Programa de Formación Permanente de la Universidad de Cádiz. Se presenta un modelo del proceso de innovación, denominado CREALAB, de elaboración propia. Este modelo se ha utilizado como base del proceso de aprendizaje de la creatividad y de la innovación y en el diseño del curso, está organizado en torno a actividades y tiene un carácter iterativo y realimentado. Se presentan además el conjunto del diseño metodológico y los resultados obtenidos en las dos ediciones celebradas hasta el momento. El diseño del curso totalmente on line y los resultados alcanzados permiten estimar un alto potencial de aplicación, tanto a nivel personal como a nivel organizacional.
Bensaja Dei Schiro, Eva Diniz; Garcia Dias, Ana Cristina; Neiva-Silva, Lucas; Nieto, Carlos Jose; Koller, Silvia Helena
En este estudio se investigo como los adolescentes con experiencia de embarazo evaluaron el apoyo que recibieron de su familia, en comparacion con un grupo de adolescentes que no habia pasado por esta experiencia...
Natalie Sánchez Benítez
Full Text Available El siguiente artículo sitúa sus relexiones sobre la maternidad desde el feminismo y describe cuáles son las e xperiencias de la maternidad cuando se es mujer feminista, para el caso especí- ico de la organización Casa de la Mujer. Los ejes de análisis son: i la experiencia ambivalente del deseo; ii las experiencias de exclusión y vulneración; iii pareja y crianza, encuentros y desencuentros; y iv autonomía. Se concluye que en la experiencia hay varios elementos que potencian la reconiguración subjetiva de las mujeres madres y no madres, feministas y no feministas.
Endoscopy has a crucial role in the diagnosis, management, and surveillance of inflammatory bowel disease (IBD). It contributes in supporting the diagnosis of IBD with the clinical history, physical examination, laboratory findings, and targeted biopsies. Furthermore, endoscopy has a significant role in assessing disease activity and distribution in treatment efficacy evaluation, post-surgical recurrence risk, and cancer surveillance in patients with long-lasting illness. Endoscopy also provides therapeutic potential for the treatment of IBD, especially with stricture dilatation and treatment of bleeding. Small bowel (SB) endoscopy (capsule endoscopy and device-assisted enteroscopy) and cross-sectional radiologic imaging (computed tomography enterography and magnetic resonance enterography) have become important diagnostic options to diagnose and treat patients with SB Crohn's disease. We reviewed the present role of SB endoscopy in patients with SB Crohn's disease. PMID:27433142
Nora E. Burkart
Full Text Available Background. Diagnosis and management of Clostridium difficile infection (CDI rely upon clinical assessments and diagnostic studies. Among diagnostic tests, lower gastrointestinal (GI endoscopy in the setting of CDI remains controversial. Objective. To describe the role of lower endoscopy in CDI management. Methods. Retrospective study of lower endoscopies in CDI at four metropolitan hospitals, July 2005 through December 2007. Results. Of 1760 CDI inpatients, 45 lower endoscopies were performed on 43 patients. Most common indications were ruling out other etiologies (42%, inconclusive stool studies (36%, and worsening course (11%. Most endoscopies (73% had positive findings, including pseudomembranous colitis (49% and nonspecific colitis (24%. Biopsies were performed in 31 cases, more with nonspecific colitis (10/11, 92% compared to pseudomembranous colitis (14/22, 64%. Conclusion. While not recommended as a primary screening tool, lower GI endoscopy can add valuable information in CDI when other colonic pathologies may exist, studies are inconclusive, or clinical status worsens.
Susana Beatriz Fernandes
Este artículo analiza y problematiza el proceso de producción de una investigación desarrollada con un grupo de niños en edad escolar, partiendo de la idea de experiencia desde lo punto de vista de Michel Foucault. Llama la atención sobre sus posibilidades y sus dificultades en el proceso, contraponiendo la perspectiva de una investigación-experiencia con la de una investigación-verdad. Discute los caminos de la investigación recorrido, sus particularidades y contingencias, dando énfasis la...
María Isabel Lafuente Guantes
Full Text Available En este trabajo se considera la forma de entender la calidad en la experiencia docente en educación superior a partir de la práctica del profesorado, y en relación con las orientaciones educativas hoy al uso. Se analiza en tres trabajos: las nociones en que se basa esta experiencia, su valor en el proceso docente, qué condiciones se requieren para lograr que la creencia en la calidad alcance su efectuación.
Full Text Available Este trabajo analiza las experiencias migratorias de mujeres y hombres japoneses que residen en la ciudad de Madrid (España y ocupan diversas posiciones sociales. El objetivo que perseguimos con nuestro análisis es centrarnos en dichas experiencias como un aspecto relevante de las luchas simbólicas que van progresivamente construyendo las posiciones, prácticas e identidades de unos grupos en relación con los otros en diversos ámbitos urbanos (trabajo, vecindad, educativos, etc..
Mery Luz Valderrama Sanabria
Introducción: El objetivo de la investigación fue describir la experiencia de profesionales de enfermería en cargos administrativos en salud para fomentar el liderazgo en el futuro profesional de enfermería. Materiales y Métodos: Investigación cualitativa tipo descriptivo, con diseño narrativo de tópicos puesto que se enfoca en una temática que hace referencia al liderazgo en enfermería. Resultados: Se obtuvieron tres categorías: Experiencias exitosas, de la cual surgieron dos subcategorías: ...
Paula Vanessa Sánchez
En el presente artículo presento los resultados de la investigación llevada a cabo entre los años 2009 y 2010, sobre la experiencia vinculante afectiva del sujeto adolescente infractor en la ciudad de Manizales. Teóricamente la investigación se sustenta en los planteamientos de Jhon Bowlby sobre los Vínculos; epistemológicamente se fundamenta en una perspectiva construccionista que indica que los vínculos se construyen en la interacción y en la experiencia cotidiana. En lo metodológico, es...
David Silva Barrera
Full Text Available El artículo aborda la situación actual del diseño de experiencia de usuarios para los sistemas informáticos. Refleja la necesidad de encontrar una solución favorable para los usuarios. Propone entonces el montaje de un laboratorio de diseño de experiencia de usuario que brinde servicios en la empresa. La propuesta incluye la descripción de los elementos que deben incorporarse en el laboratorio.
Donald MacIntosh; Catherine Dubé; Roger Hollingworth; Sander Veldhuyzen van Zanten; Sandra Daniels; George Ghattas
BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality highlight the need for endoscopy facilities to review the quality of the service they offer.OBJECTIVE: To adapt the United Kingdom Global Rating Scale (UK-GRS) to develop a web-based and patient-centred tool to assess and improve the quality of endoscopy services provided.METHODS: Based on feedback from 22 sites across Canada that completed the...
Öner, Osman Zekai; Demirci, Rojbin Karakoyun; Gündüz, Umut Rıza; Aslaner, Arif; KOÇ, Ümit; Bülbüller, Nurullah
Bidirectional endoscopy (BE) is often used to assess patients for the reason of anemia or to screen asymptomatic population for malignancy. Limited clinical data favors to perform first the upper gastrointestinal system endoscopy, but its effect to the duration of colonoscopy is yet to be determined. The aim of this retrospective study is to evaluate the effect of upper gastrointestinal system endoscopy on the time to achieve cecal intubation during colonoscopy in patients undergoing BE. Pati...
Khamaysi, Iyad; Gralnek, Ian M
Upper gastrointestinal (UGI) endoscopy is the cornerstone of diagnosis and management of patients presenting with acute UGI bleeding. Once hemodynamically resuscitated, early endoscopy (performed within 24 hours of patient presentation) ensures accurate identification of the bleeding source, facilitates risk stratification based on endoscopic stigmata, and allows endotherapy to be delivered where indicated. Moreover, the preendoscopy use of a prokinetic agent (eg, i.v. erythromycin), especially in patients with a suspected high probability of having blood or clots in the stomach before undergoing endoscopy, may result in improved endoscopic visualization, a higher diagnostic yield, and less need for repeat endoscopy. Copyright © 2015 Elsevier Inc. All rights reserved.
Catherine T Frenette; John G Kuldau; Donald J Hillebrand; Jill Lane; Paul J Pockros
AIM: To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices.METHODS: Cirrhotic patients who were undergo-ing esophagogastroduodenoscopy (EGD) for variceal screening or surveillance underwent capsule endos-copy. Two separate blinded investigators read each capsule endoscopy for the following results: variceal grade, need for treatment with variceal banding or prophylaxis with beta-blocker therapy, degree of portal hypertensive gastropathy, and gastric varices.RESULTS: Fifty patients underwent both capsule and EGD. Forty-eight patients had both procedures on the same day, and 2 patients had capsule endoscopy within 72 h of EGD. The accuracy of capsule endos-copy to decide on the need for prophylaxis was 74%,with sensitivity of 63% and specificity of 82%. Inter-rater agreement was moderate (kappa = 0.56). Agree-ment between EGD and capsule endoscopy on grade of varices was 0.53 (moderate). Inter-rater reliability was good (kappa = 0.77). In diagnosis of portal hyper.tensive gastropathy, accuracy was 57%, with sensitiv-ity of 96% and specificity of 17%. Two patients had gastric varices seen on EGD, one of which was seen on capsule endoscopy. There were no complications from capsule endoscopy.CONCLUSION: We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with banding or beta-blocker thera-py. More data is needed to assess accuracy for staging esophageal varices, PHG, and the detection of gastric varices.
Nam, Seung-Joo; Chun, Hoon Jai; Moon, Jeong Seop; Park, Sung Chul; Hwang, Young-Jae; Yoo, In Kyung; Lee, Jae Min; Kim, Seung Han; Choi, Hyuk Soon; Kim, Eun Sun; Keum, Bora; Jeen, Yoon Tae; Lee, Hong Sik; Kim, Chang Duck
Background/Aims: The management of job-related stress among health-care workers is critical for the improvement of healthcare services; however, there is no existing research on endoscopy unit workers as a team. Korea has a unique health-care system for endoscopy unit workers. In this study, we aimed to estimate job stress and job satisfaction among health-care providers in endoscopy units in Korea. Methods: We performed a cross-sectional survey of health-care providers in the endoscopy units...
Sabzevari, Alireza; Kianifar, Hamidreza; Jafari, Seyed Ali; Saeidi, Masumeh; Ahanchian, Hamid; Kiani, Mohammad Ali; Jarahi, Lida
Gentle music has relaxing and pain reducing effects. In this study, the effect of music on patients' vital signs and pain was investigated before and after endoscopy. This clinical trial study was conducted on 100 children from seven to fourteen years of age in Gha'em Hospital, Mashhad in 2015. Children were divided into two equal groups (case group=50 and control group=50). The control group received endoscopy according to the standards, without any other procedure. For the case group, a classic musical piece by Clayderman was played during endoscopy (from the time of entering the endoscopy room to the end of the process). After conducting endoscopy, FALCC scale and Baker-Wong pain scale were filled for both groups. In addition, children's vital signs including: heart rate (pulse), diastolic and systolic blood pressure were measured before and after endoscopy for both groups. Data analysis was conducted using SPSS16 with the help of Mann-Whitney and Chi-square tests. No significant difference was found in age, gender distribution of case or control groups (p>0.05). Heart rate and diastolic blood pressure was significantly lower in the music (case) group compared to the control group before endoscopy (p=0.012). In addition, pain score in patients of the music group was lower than the control group (pmusic for children during endoscopy can reduce pain and anxiety in patients before and after endoscopy.
Alejandro Parra; Romina Mielgo
RESUMENLa experiencia fuera del cuerpo (EFC) se define como un experiencia mediante la cual el “yo” o centro de conciencia parece ocupar una posición remota respecto a su propio cuerpo. Un total de 648 estudiantes de psicología que incluyó 78% de mujeres y 24% de hombres, completaron un número de escalas para comparar los puntajes de ambos grupos (con EFC N = 132 vs sin EFC N = 516). Los resultados mostraron mayor esquizotipia cognitivo-perceptual, absorción, disociación, propensidad a la fan...
European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anaesthesiologist administration of propofol for GI endoscopy
Dumonceau, J.M.; Riphaus, A.; Aparicio, J.R.
Propofol sedation by non-anaesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this ev......Propofol sedation by non-anaesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim...... of this evidence- and consensus-based set of guideline is to provide non-anaesthesiologists with a comprehensive framework for propofol sedation during digestive endoscopy. This guideline results from a collaborative effort from representatives of the European Society of Gastrointestinal Endoscopy (ESGE...
European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy
Dumonceau, J.M.; Riphaus, A.; Aparicio, J.R.
Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this evi......Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim...... of this evidence- and consensus-based set of guideline is to provide non-anesthesiologists with a comprehensive framework for propofol sedation during digestive endoscopy. This guideline results from a collaborative effort from representatives of the European Society of Gastrointestinal Endoscopy (ESGE...
Santos Raga, Arturo
El artículo presenta un análisis de cómo se constituye la experiencia hegeliana en tanto saber real, como modo de ser del espíritu absoluto, para llegar a la "experiencia" que el absuluto tiene de sí mismo, de su máxima intimidad; esto es, cuando el espíritu ha conquistado su verdad y se ha elevado a la experiencia filosófica. Se propone demostrar que no hay un cancelamiento de la experiencia en el espíritu absoluto, e indicar al principppal cambio hegeliano en la teoría de la experiencia: la...
Full Text Available OBJETIVO: Explorar la experiencia de envejecimiento de hombres y mujeres mayores de 60 años, que viven en contextos rurales de pobreza en los estados de Guerrero y Morelos, México. MATERIAL Y MÉTODOS: Se diseñó un estudio cualitativo basado en entrevistas semiestructuradas. Se trabajó en comunidades con menos de 2 500 habitantes, pobres y de alta marginación. RESULTADOS: La experiencia de envejecimiento es radicalmente diferente según la condición de género; esta vivencia resulta ser más positiva para las mujeres. La soledad es un factor que configura la experiencia diferencial del envejecimiento, así como las redes sociales y el estado de salud-enfermedad. Los principales temores asociados a la vejez fueron la soledad, la enfermedad, la pobreza y la pérdida de independencia. CONCLUSIONES: La identidad de género desempeña un papel fundamental en la configuración de la experiencia diferencial del proceso de envejecimiento, debido a que las oportunidades de desarrollo y las responsabilidades que se derivan de ella, promueven la desigualdad entre los sexos. Es necesario hacer más eficiente la respuesta institucional, de manera que responda a las necesidades específicas de esta población.
Full Text Available Video capsule endoscopy (VCE has recently been introduced to fill the gap between examinations of the upper and lower gastrointestinal tract, mainly to examine the small bowel (SB for sources of obscure bleeding in addition to many other indications. VCE represents a minute endoscope, embedded in a swallowable capsule that is propelled by peristalsis and achieves the journey to the right colon in 5-8 hours. Images captured by the capsule are recorded on a hard drive attached to the patient′s belt. Many studies have recently shown that the diagnostic yield of VCE is superior to that of push enteroscopy. This mini-review contains information on the technical aspects, indications, safety and tolerance of VCE. It is well known that radiological investigations of the small bowel (SB have a limited diagnostic yield, are relatively invasive, and often lead to late discovery of diseases, especially malignancy and profuse bleeding, at a worse stage. Also, push enteroscopy is limited by the depth of the insertion of the instrument to the proximal jejunum and, in the retrograde, to the last 50-80 cm of the terminal ileum, with an ability to visualize the entire SB only in 10-70% of cases. Introduction of video capsule endoscopy (VCE is therefore regarded a significant advance in investigating intestinal diseases, and closes the gap in evaluating the SB, "the black box" of endoscopy(1. This mini-review describes the current indications of VCE and the prerequisites for accurate examination, and briefly discusses its tolerance and safety.
Baeg, Myong Ki; Lim, Chul-Hyun; Kim, Jin Su; Cho, Yu Kyung; Park, Jae Myung; Lee, Bo-In; Lee, In-Seok; Choi, Myung-Gyu
Abstract Background: A portable disposable ultrathin endoscope (DUE) with high visual quality and maneuverability would reduce the need for expensive facilities and emergency endoscopy could be available anywhere. It would increase patient satisfaction, prevent unnecessary sedation, and reduce infection. Our aim was to evaluate the usefulness of portable DUE in performing percutaneous endoscopic gastrostomy (PEG). Methods: We prospectively enrolled patients who underwent PEG under DUE guidance and compared them with historical controls who underwent PEG under conventional ultrathin endoscopy (CUE) guidance. The primary outcomes were successful stomach visualization and PEG tube insertion. Results: Twenty-five patients (19 male) were enrolled and compared with 25 gender and indication-matched controls. The most common indications for PEG were aspiration due to stroke or brain injury, dementia, and head and neck cancer. Entrance into the stomach was achieved in 92.0% (23/25) and 96% (24/25) in the DUE and CUE groups, and PEG was performed in 91.3% (21/23) and 95.8% (23/24), respectively. The mean insertion time for the DUE and CUE groups were 22.7 ± 9.3 minutes and 17.1 ± 5.7 minutes (P = 0.044). The 3 cases of failure to reach the stomach in both groups were caused by esophageal blockage. The 3 cases of failed PEG tube insertion were caused by poor visualization of the insertion site. Bleeding and pneumoperitoneum occurred in 1 and 2 patients in the DUE group. One case of fever was noted in the CUE group. All adverse events were conservatively managed. Conclusions: Our study shows that portable DUE in facilities without endoscopy equipment may be clinically feasible. PMID:27902596
A E Karateyev
Full Text Available The paper describes a procedure for capsular endoscopy (CE, a new high-technology method of evaluating the small bowel, and reports on its use in rheumatological care. Small bowel involvement is noted to be frequently encountered in rheumatic diseases, such as Behcet's disease, diffuse scleroderma, and seronegative spondylitis. According to the data of clinical trials, CE is effective in timely detecting this visceral abnormality. At the same time, CE is actually the only accurate method of diagnosing drug-induced enteropathy, a potentially menacing disease that frequently occurs with the use of nonsteroidal anti-inflammatory drugs.
Aaron C. Lin
Full Text Available Pediatric obstructive sleep apnea (OSA is not always resolved or improved with adenotonsillectomy. Persistent or complex cases of pediatric OSA may be due to sites of obstruction in the airway other than the tonsils and adenoids. Identifying these areas in the past has been problematic, and therefore, therapy for OSA in children who have failed adenotonsillectomy has often been unsatisfactory. Sleep endoscopy is a technique that can enable the surgeon to determine the level of obstruction in a sleeping child with OSA. With this knowledge, site-specific surgical therapy for persistent and complex pediatric OSA may be possible.
Bjorkman, David J
There is general consensus in national and societal guidelines that training for sedation should be part of basic training for endoscopy. There is no clear consensus, however, on the structure of that training. More importantly, these same guidelines are often silent on the specific requirements to demonstrate competency for administration of sedation, ways to document that competency and measures to assure that competency is maintained. In the absence of data demonstrating improved outcomes with specific approaches, the process and principles in this paper are proposed as a starting point to be modified by future research and data.
Full Text Available Endoscopy instruction has progressed a great deal in recent years, evolving from the age-old dictum of ‘see one, do one’ to the current skillful application of sound educational principles. Some of these educational principles are generic and applicable to the teaching of any content at all levels, while others are quite specific to technical skills training. The present review summarizes these important principles under the following headings: creating a learner-centred curriculum; delivering an achievable learning task; and moving from theory to practice. The present article challenges national gastroenterology organizations to embrace these concepts in structured, outcome-based educational programs.
Mitchell; M; Lee; Andrew; Jacques; Eric; Lam; Ricky; Kwok; Pardis; Lakzadeh; Ajit; Sandhar; Brandon; Segal; Sigrid; Svarta; Joanna; Law; Robert; Enns
AIM:To identify patient risk factors associated with incomplete small bowel capsule endoscopy(CE) studies.METHODS:Data from all CE procedures performed at St.Paul's Hospital in Vancouver,British Columbia,Canada,between December 2001 and June 2008 were collected and analyzed on a retrospective basis.Data collection for complete and incomplete CE study groups included patient demographics as well as a number of potential risk factors for incomplete CE including indication for the procedure,hospitalization,dia...
Richter, James M; Kelsey, Peter B; Campbell, Emily J
Gastrointestinal endoscopy is a remarkably safe set of diagnostic and therapeutic techniques, and yet a small number of significant complications and adverse events are expected. Serious complications may have a material effect on the patient's health and well-being. They need to be anticipated and prevented if possible and managed effectively when identified. When complications occur they need to be discussed frankly with patients and their families. Informed consent, prevention, early detection, reporting, and systems improvement are critical aspects of effective complication management. Optimal complication management may improve patient satisfaction and outcome, as well as preserving the reputation and confidence of the endoscopist, and may minimize litigation.
Endoscopy has important roles in the managementof primary sclerosing cholangitis （PSC）, ranging fromnarrowing down the differential diagnoses, screeningfor complications, determining prognosis and therapy.While the need for a diagnostic endoscopic retrogradecholangiopancreatography （ERCP） may be obviated by apositive magnetic resonance cholangiopancreatography（MRCP）, a negative MRCP does not exclude PSC andmay therefore necessitate an ERCP, which is traditionallyregarded as the gold standard. In this editorial we havenot covered the endoscopic management of inflammatorybowel disease in the context of PSC nor of endoscopicsurveillance and treatment of portal hypertension complicatingPSC.
Koo, Pyung-Hoi; Nielsen, Karl Brian; Jang, Jaejin
One of the major elements in improving efficiency of healthcare services is patient flow. Patients require a variety of healthcare resources as they receive healthcare services. Poor management of patient flow results in long waiting time of patients, under/over utilization of medical resources......, low quality of care and high healthcare cost. This article addresses patient flow problems at a Gastrointestinal endoscopy unit. We attempt to analyze the main factors that contribute to the inefficient patient flow and process bottlenecks and to propose efficient patient scheduling and staff...
Carmelo Luigiano; Giuseppe Iabichino; Antonino Judica; Clara Virgilio; Valentina Peta; Ludovico Abenavoli
The management of patients with gastrointestinalcomplications of portal hypertension is often complexand challenging. The endoscopy plays an importantrole in the management of these patients. The role ofendoscopy is both diagnostic and interventional andin the last years the techniques have undergone arapid expansion with the advent of different and novelendoscopic modalities, with consequent improvementof investigation and treatment of these patients. Thechoice of best therapeutic strategy depends on manyfactors baseline disease, patient＇s clinical performanceand the timing when it is done if in emergency or aprophylactic approaches. In this review we evaluatethe endoscopic management of patients with thegastrointestinal complications of portal hypertension.
EXPERIENCIAS EXTRASENSORIALES Y EXPERIENCIAS ALUCINATORIAS: EXAMINANDO LA HIPÓTESIS DEL CONTINUO DE EXPERIENCIAS ESQUIZOTÍPICAS/ EXTRASENSORIAL AND HALLUCINATORY EXPERIENCES: EXAMINING THE CONTINUOUS THEORY ON SCHIZOTYPAL EXPERIENCES
Full Text Available RESUMENUna experiencia extrasensorial es aquella en la que parece que la mente de una persona ha adquirido la informaciónremota, es decir, aparentemente sin la mediación de los sentidos humanos conocidos o procesos de inferencia lógica. Portanto, lo «extrasensorial» en la experiencia extrasensorial corresponde a juzgar por las apariencias y no necesariamente a larealidad, mientras que lo «extrasensorial» en la percepcion extrasensorial se refiere a la naturaleza de una presunta realidadparanormal. Se ponen a prueba dos hipótesis específicas: Una muestra de estudiantes argentinos que reportan haber tenidoexperiencias extrasensoriales tienen mayor capacidad de experimentar (1 alucinaciones visuales y táctiles, y (2 propensióna la esquizotipia en comparación con quienes no tuvieron experiencias extrasensoriales. Los resultados mostraron mayornivel de esquizotipia cognitivo-perceptual y propensión a la alucinación en individuos con experiencias que quienes no lastuvieron. Los resultados sugieren que hay procesos disociativos subyacentes, como absorción y propensión a la fantasía,que parecen estar asociadas a las experiencias extrasensoriales.ABSTRACTAn extrasensory experience is one in which it appears that the experient’s mind has acquired information directly, thatis, seemingly without either the mediation of the recognized human senses or the processes of logical inference. The«extrasensory» in extrasensory experience therefore pertains to appearances and not necessarily to reality, whereas the«extrasensory» in extrasensory perception refers to the nature of a hypothesized paranormal reality. Two specific hypothesesare tested: A sample of Argentinean participants who have reported Extrasensorial experiences have a higher capacity for (1visual and tactile hallucination, and (2 schizotypy proneness than non--experients. The results showed a higher level ofcognitive-perceptual schizotypy and hallucination proneness in
Paz Flores; Carmen Masferrer; Eithne Leahy; Roser Izquierdo; Eduard Palomer
Se relata la experiencia del proyecto EMILIA y se ofrece una visión global de qué se entiende por “usuario experto” y “implicación de los usuarios” en salud mental. Se discuten sus implicaciones para los profesionales, usuarios y el sistema sanitario.
Laura E Targownik
Full Text Available BACKGROUND: Performance of endoscopy within 24 h is recommended for patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB. It is unknown whether performing endoscopy early within this 24 h window is beneficial for clinically high-risk patients.
Full Text Available BACKGROUND: High-quality processes to ensure infection prevention and control in the delivery of safe endoscopy services are essential. In 2010, the Public Health Agency of Canada and the Canadian Association of Gastroenterology (CAG developed a Canadian guideline for the reprocessing of flexible gastrointestinal endoscopy equipment.
Full Text Available Aim: Our aim was to identify the characteristics of the patient that performed upper gastrointestinal endoscopy in a new established endoscopy unit of a state hospital. We want to present the spectrum of gastrointestinal diseases in our hospitals region. Material and Method: We analyzed patients upper endoscopy results according to age, sex, complaints, clinical characteristics, type of anesthesia, and the necessity of biopsy. We reviewed 256 patients data between 2013 December-2014 July. All endoscopies were performed by same surgeon. Results: The highest complaint was epigastric pain (n=112, 43, 8%. Other complaints were followed as dyspepsia (n=84, 32.8%, heartburn (n=42, 16.4%, nausea (n=4, 1.6%, vomiting (n=2, 0.8%, dysphagia (n=6, 2.3%. We determined 218 gastritis (85.2%, 64 hiatal hernia (25%, 120 esophagitis (46.9%, 76 duodenitis (29.7%, 4 gastric ulcer (1.6%, 18 duodenal ulcers (7%, 20 bile reflux (7.8%, 26 Gastro esophageal reflux disease (GERD in patients (10.2%. 10 patients reported as normal (3.9%. Biopsy was performed in 186 of the patients. Discussion: Endoscopy can become an early diagnostic examination by increasing the availability of endoscopy. Also alarm symptoms should not be ignored and endoscopy should perform immediately in symptomatic patients. As an early result of upper gastrointestinal endoscopies that performed in this study; gastritis, esophagitis, duodenitis and hiatal hernia are common gastrointestinal diseases in our region.
Full Text Available BACKGROUND: Wireless capsule endoscopy (CE is increasingly being used in the investigation of obscure gastrointestinal (GI bleeding, but some studies have found that many of the bleeding lesions recognized by this technique are within the reach of conventional endoscopy.
Spaander, Manon C W; Baron, Todd H; Siersema, Peter D; Fuccio, Lorenzo; Schumacher, Brigitte; Escorsell, Àngels; Garcia-Pagán, Juan-Carlos; Dumonceau, Jean-Marc; Conio, Massimo; de Ceglie, Antonella; Skowronek, Janusz; Nordsmark, Marianne; Seufferlein, Thomas; Van Gossum, André; Hassan, Cesare; Repici, Alessandro; Bruno, Marco J
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). Th
Slagelse, Charlotte; Vilmann, Peter; Hornslet, Pernille;
. The existing literature on capnography for endoscopy patients sedated with nurse-administered propofol sedation (NAPS) is limited. Can the addition of capnography to standard monitoring during endoscopy with NAPS reduce the number, duration, and level of hypoxia. Materials and methods. This study...
Nakano, Toru; Sato, Chiaki; Sakurai, Tadashi; Kamei, Takashi; Nakagawa, Atsuhiro; Ohuchi, Noriaki
In recent years, water jet instruments have been used in the field of gastrointestinal endoscopy, mainly in two clinical situations: Investigation and treatment under endoscopic view. Injecting water jet into the gastrointestinal lumen is helpful for maintaining a clear endoscopic view, washing away blood or mucous in the lumen or on the surface of the tip of the endoscope. This contributes to reducing time and discomfort of examination. Water jet technology is an alternative method for dissecting soft tissue; this method does not harm the small vessels or cause mechanical or thermal damage. However, its use in clinical settings has been limited to the transmucosal injection of water into the submucosal layer that elevates the mucosa to prepare for endoscopic mucosal resection or endoscopic submucosal dissection, instead of tissue dissection, which may occur because of the continuous water jet. A preclinical study has been conducted using a pulsed water jet system as an alternative method for submucosal dissection by reducing intraoperative water consumption and maintenance of dissection capability. This review introduces recent studies pertaining to using a water jet in gastrointestinal endoscopy and discusses future prospects.
LIM; Eng-Gee; 王炤; 陈瑾慧; TILLO; Tammam; MAN; Ka-lok
Wireless capsule endoscopy(WCE) is a promising technique which has overcome some limitations of traditional diagnosing tools, such as the comfortlessness of the cables and the inability of examining small intestine section. However, this technique is still far from mature and asks for the feasible improvements. For example, the relatively low transmission data rate and the absence of the real-time localization information of the capsule are all important issues. The studies of them rely on the understanding of the electromagnetic wave propagation in human body. Investigation of performance of WCE communication system was carried out by studying electromagnetic(EM) wave propagation of the wireless capsule endoscopy transmission channel. Starting with a pair of antennas working in a human body mimic environment, the signal transmissions and attenuations were examined. The relationship between the signal attenuation and the capsule(transmitter) position, and direction was also evaluated. These results provide important information for real-time localization of the capsule. Moreover, the pair of antennas and the human body were treated as a transmission channel, on which the binary amplitude shift keying(BASK) modulation scheme was used. The relationship between the modulation scheme, data rate and bit error rate was also determined in the case of BASK. With the obtained studies, it make possible to provide valuable information for further studies on the selection of the modulation scheme and the real-time localization of the capsules.
Full Text Available Despite the best medical and endoscopic efforts, some patients with nonvariceal upper gastrointestinal bleeding suffer recurrences. Because high risk stigmata (visible vessels, active bleeders and adherent clots often persist despite apparently successful initial hemostasis and have a variable natural history, it would seem reasonable to at least consider a routine second look endoscopy. However, a review of the literature revealed six randomized trials that, in aggregate, do not support such a strategy. In fact, a second look does not appear to be effective and is associated with an increased number of procedures, treatment sessions and possibly retreatment-related complications. In addition, the cointerventions in these trials are already out of date and the potential absolute risk reductions are low when a second look is used with intravenous proton pump inhibitors and/or the application of endoscopic hemoclips or combination endoscopic therapy. Finally, the Forrest classification may provide dangerously misleading estimates of prognosis because it is being used out of context. This review critically analyzes routine second look endoscopy.
Djibril, M A; M'Ba, K B; Kaaga, Y L; Bagny, A; Edou, K A; Redah, D; Agbetra, A
The purpose of this report was to describe the profile of esogastroduodenal disease diagnosed by upper digestive tract endoscopy (UDTE) in a rural area of Togo. This prospective study combines data collected during two two-week screening campaigns carried out in the Kara region. Patients were informed of the presence of the endoscopy team by means of a bulletin on a rural radio station. All male and female patients 15 years or older were included. A total of 220 UDTE procedure reports were recorded and analyzed including 107 men and 113 women with a mean age of 37.7 years (range: 15-84 years). Disease was detected in 72 procedures mainly in the 21 to 41 year age group (47.2 %) with a higher proportion of men than women: 38% versus 27% respectively. The most frequent indications for UDTE were epigastralgia (47.7 %) including 39% of procedures leading to the discovery of disease and diffuse abdominal pain (21.8 %). The procedure was carried out for follow-up purposes in 19.1% of cases. The most common lesions were peptic ulcer (34.2%), inflammatory disease including esophagitis, gastritis, and bulboduodenitis (32.4%), gastroduodenal bile reflux (9.3%), pylorobulbar stenosis (5.5%), tumoral disease (3.7%), and esophageal varicosities (3.7%). This study based on UDTE diagnostic procedures provided insight into the profile of esogastroduodenal disease in rural Africa. These screening campaigns required special organization using appropriate equipment and personnel.
Taylan Kav; Yusuf Bayraktar
Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its efficacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases.Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bidirectional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.
García-García, María Luisa; Martín-Lorenzo, Juan Gervasio; Torralba-Martínez, José Antonio; Lirón-Ruiz, Ramón; Miguel Perelló, Joana; Flores Pastor, Benito; Pérez Cuadrado, Enrique; Aguayo Albasini, José Luis
Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm. From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy. Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1(st)-6(th) postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively. Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Glukhovsky, A; Jacob, H
The introduction of the Video Capsule Endoscope (VCE) by Given Imaging Ltd. (Yoqneam, Israel) in 2001, and its subsequent approval by the FDA as a first line tool in the detection of abnormalities of the small bowel, is indicative of the rapid acceptance of capsule endoscopy by the practicing gastroenterological community. An extensive clinical trials program consistently revealed a high diagnostic yield of the VCE when compared to other diagnostic modalities of the small intestine. The capsule endoscope contains a miniature color video camera, illumination sources, lens, transmitter/controller, antenna, and a power source. It is small enough to easily swallow (11 x 26 mm), and it is propelled through the gastrointestinal (GI) tract by peristalsis. Its development was enabled by a series of technological breakthroughs that occurred at the close of the 20th century. The VCE is one of the most exciting examples of the recent trend for minimally invasive autonomous medical tools in diagnostic, monitoring, and therapeutic applications. Expanding applications of the VCE to additional parts of the GI tract, adding physiological sensors, and--in the more remote future--addition of therapeutic capabilities will likely occur as this new branch of endoscopy develops.
Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi
Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592
Usón-Gargallo, Jesús; Usón-Casaús, Jesús M; Pérez-Merino, Eva M; Soria-Gálvez, Federico; Morcillo, Esther; Enciso, Silvia; Sánchez-Margallo, Francisco M
This article reports on the face, content, and construct validity of a new realistic composite simulator (Simuldog) used to provide training in canine gastrointestinal flexible endoscopy. The basic endoscopic procedures performed on the simulator were esophagogastroduodenoscopy (EGD), gastric biopsy (GB), and gastric foreign body removal (FBR). Construct validity was assessed by comparing the performance of novices (final-year veterinary students and recent graduates without endoscopic experience, n=30) versus experienced subjects (doctors in veterinary medicine who had performed more than 50 clinical upper gastrointestinal endoscopic procedures as a surgeon, n=15). Tasks were scored based on completion time, and specific rating scales were developed to assess performance. Internal consistency and inter-rater agreement were assessed. Face and content validity were determined using a 5-point Likert-type scale questionnaire. The novices needed considerably more time than the experts to perform EGD, GB, and FBR, and their performance scores were significantly lower (pendoscopy scenarios were very realistic. The experts highly valued the usefulness of Simuldog for veterinary training and as a tool for assessing endoscopic skills. Simuldog is the first validated model specifically developed to be used as a training tool for endoscopy techniques in small animals.
Over the past 30 years, the field of endoscopy haswitnessed several advances. With the advent ofendoscopic mucosal resection, removal of large mucosallesions have become possible. Thereafter, endoscopicsubmucosal resection was refined, permitting en blocremoval of large superficial neoplasms. Such techniqueshave facilitated the development of antirefluxmucosectomy, a promising novel treatment for gastroesophagealreflux. The introduction and use of overthe scope clips has allowed for endoscopic closureof defects in the gastrointestinal tract, which weretraditionally treated with surgical intervention. With thedevelopment of per-oral endoscopic myotomy （POEM）,the treatment of achalasia and spastic disorders ofthe esophagus have been revolutionized. From thesubmucosal tunnelling technique developed for POEM,Per oral endoscopic tumor resection of subepithelialtumors was made possible. Simultaneously, advancesin biotechnology have expanded esophageal stentingcapabilities with the introduction of fully covered metaland plastic stents, as well as biodegradable stents.Once deemed a primarily diagnostic tool, endoscopy hasquickly transcended to a minimally invasive interventionand therapeutic tool. These techniques are reviewedwith regards to their application to benign disease ofthe esophagus.
This article reviews some of the technical developments that allowed the introduction of the wireless capsule 10 years ago into human usage. Technical advances and commercial competition have substantially improved the performance of clinical capsule endoscopy, especially in optical quality. Optical issues including the airless environment, depth of focus, dome reflection, the development of white light light-emitting diodes, exposure length and the advent of adaptive illumination are discussed. The competition between charge coupled devices and complementary metal oxide silicone technologies for imaging, lens improvements and the requirements for different frame rates and their associated power management strategies and battery type choices and the introduction of field enhancement methods into commercial capsule technology are considered. Capsule technology stands at a watershed. It is mainly confined to diagnostic small intestinal imaging. It might overtake other forms of conventional diagnostic endoscopy, especially colonoscopy but also gastroscopy and esophagoscopy but has to improve both technically and compete in price. It might break out of its optical diagnostic confinement and become a therapeutic modality. To make this leap there have to be several technical advances especially in biopsy, command, micromechanical internal movements, remote controlled manipulation and changes in power management, which may include external power transmission.
Yamashita, Eduardo Tomohissa; Takahashi, Wagner; Kuwashima, Daniel Yuiti; Langoni, Tiago Ribeiro; Costa-Genzini, Adriana
Ascaris lumbricoides (A. lumbricoides) is the most common intestinal roundworm parasite, infecting approximately one quarter of the world's population. Infection can lead to various complications because it can spread along the gastrointestinal tract. Although A. lumbricoides infection is a serious healthcare issue in developing countries, it now also has a worldwide distribution as a result of increased immigration and travel. Intestinal obstruction is the most common complication of A. lumbricoides infection, potentially leading to even more serious consequences such as small bowel perforation and peritonitis. Diagnosis is based primarily on stool samples and the patient's history. Early diagnosis, aided in part by knowledge of the local prevalence, can result in early treatment, thereby preventing surgical complications associated with intestinal obstruction. Further, delay in diagnosis may have fatal consequences. Capsule endoscopy can serve as a crucial, non-invasive diagnostic tool for A. lumbricoides infection, especially when other diagnostic methods have failed to detect the parasite. We report a case of A. lumbricoides infection that resulted in intestinal obstruction at the level of the ileum. Both stool sample examination and open surgery failed to indicate the presence of A. lumbricoides, and the cause of the obstruction was only revealed by capsule endoscopy. The patient was treated with anthelmintics.
Jorge Pablo Batista
Full Text Available Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.
Laursen, Stig B; Leontiadis, Grigorios I; Stanley, Adrian J;
BACKGROUND AND AIMS: The optimal timing of endoscopy in patients with peptic ulcer bleeding (PUB) remains unclear. The aim of this study was to examine the association between timing of endoscopy and mortality in PUB. METHODS: A nationwide cohort study based on a database of consecutive patients...... admitted to hospital with PUB in Denmark. Patients were stratified according to presence of hemodynamic instability at presentation and American Society of Anesthesiologists (ASA) score. Using descriptive statistics and logistic regression analyses, we identified optimal time frames for endoscopy...... and analyzed the association between timing of endoscopy and in-hospital mortality after adjusting for confounding factors. RESULTS: A total of 12,601 patients were included. We did not find any universal association between timing of endoscopy and mortality in hemodynamically stable patients with an ASA...
Michael F Byrne
Full Text Available Over the past decade, multiple clinical reports have demonstrated that the use of propofol sedation for gastrointestinal endoscopy by gastroenterologists and trained endoscopy nurses is safe and effective in appropriately selected patients. Proposed benefits of propofol sedation include rapid onset of action, improved patient comfort and rapid clearance, as well as prompt recovery and discharge from the endoscopy unit. As a result of medical evidence, a number of international professional societies have endorsed the use of propofol in gastrointestinal endoscopy. In Canada, no formal guidelines currently exist. In the present article, the Clinical Affairs Committee of the Canadian Association of Gastroenterology presents a position statement, incorporating updated information on the use of propofol sedation for endoscopy in adult patients.
Stephen J Heller
Full Text Available Stephen J Heller, Jeffrey L TokarDepartment of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USAAbstract: Rapid growth in the field of advanced gastrointestinal endoscopy has led to an increase in specialized therapeutic endoscopy fellowships. The cornerstones of these programs are training in endoscopic retrograde cholangiopancreatography (ERCP and endoscopic ultrasound. These procedures are more complex and challenging to master than routine colonoscopy and upper endoscopy, and in the case of ERCP, higher risk. The concentration of the educational experience in the hands of relatively fewer trainees with specialized interest in advanced endoscopy has resulted in providing a focused cohort of graduating fellows with higher case volumes in training, which likely enhances diagnostic and therapeutic success and safer performance of these procedures. Endoscopic simulators, although not currently in widespread use, have the potential to improve advanced procedural training without jeopardizing patient safety.Keywords: gastrointestinal endoscopy, training, procedures, safety
Meltzer, Andrew C; Ali, M Aamir; Kresiberg, Roderick B; Patel, Gayatri; Smith, Jeff P; Pines, Jesse M; Fleischer, David E
Video capsule endoscopy has been used to diagnose gastrointestinal hemorrhage and other small bowel diseases but has not been tested in an emergency department (ED) setting. The objectives in this pilot study are to demonstrate the ability of emergency physicians to detect blood in the upper gastrointestinal tract with capsule endoscopy after a short training period, measure ED patient acceptance of capsule endoscopy, and estimate the test characteristics of capsule endoscopy to detect acute upper gastrointestinal hemorrhage. During a 6-month period at a single academic hospital, eligible patients underwent video capsule endoscopy (Pillcam Eso2; Given Imaging) in the ED. Video images were reviewed by 4 blinded physicians (2 emergency physicians with brief training in capsule endoscopy interpretation and 2 gastroenterologists with capsule endoscopy experience). A total of 25 subjects with acute upper gastrointestinal hemorrhage were enrolled. There was excellent agreement between gastroenterologists and emergency physicians for the presence of fresh or coffee-ground blood (0.96 overall agreement; κ=0.90). Capsule endoscopy was well tolerated by 96% of patients and showed an 88% sensitivity (95% confidence interval 65% to 100%) and 64% specificity (95% confidence interval 35% to 92%) for the detection of fresh blood. Capsule endoscopy missed 1 bleeding lesion located in the postpyloric region, which was not imaged because of expired battery life. Video capsule endoscopy is a sensitive way to identify upper gastrointestinal hemorrhage in the ED. It is well tolerated and there is excellent agreement in interpretation between gastroenterologists and emergency physicians. Copyright © 2012. Published by Mosby, Inc.
Gralnek, I M; Ching, J Y L; Maza, I; Wu, J C Y; Rainer, T H; Israelit, S; Klein, A; Chan, F K L; Ephrath, H; Eliakim, R; Peled, R; Sung, J J Y
Capsule endoscopy may play a role in the evaluation of patients presenting with acute upper gastrointestinal hemorrhage in the emergency department. We evaluated adults with acute upper gastrointestinal hemorrhage presenting to the emergency departments of two academic centers. Patients ingested a wireless video capsule, which was followed immediately by a nasogastric tube aspiration and later by esophagogastroduodenoscopy (EGD). We compared capsule endoscopy with nasogastric tube aspiration for determination of the presence of blood, and with EGD for discrimination of the source of bleeding, identification of peptic/inflammatory lesions, safety, and patient satisfaction. The study enrolled 49 patients (32 men, 17 women; mean age 58.3 ± 19 years), but three patients did not complete the capsule endoscopy and five were intolerant of the nasogastric tube. Blood was detected in the upper gastrointestinal tract significantly more often by capsule endoscopy (15 /18 [83.3 %]) than by nasogastric tube aspiration (6 /18 [33.3 %]; P = 0.035). There was no significant difference in the identification of peptic/inflammatory lesions between capsule endoscopy (27 /40 [67.5 %]) and EGD (35 /40 [87.5 %]; P = 0.10, OR 0.39 95 %CI 0.11 - 1.15). Capsule endoscopy reached the duodenum in 45 /46 patients (98 %). One patient (2.2 %) had self-limited shortness of breath and one (2.2 %) had coughing on capsule ingestion. In an emergency department setting, capsule endoscopy appears feasible and safe in people presenting with acute upper gastrointestinal hemorrhage. Capsule endoscopy identifies gross blood in the upper gastrointestinal tract, including the duodenum, significantly more often than nasogastric tube aspiration and identifies inflammatory lesions, as well as EGD. Capsule endoscopy may facilitate patient triage and earlier endoscopy, but should not be considered a substitute for EGD. © Georg Thieme Verlag KG Stuttgart · New York.
Enrique de Teresa
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"Habiendo educado mis ojos en el espectáculo de las cosas, intento deciros lo bello que he encontrado" Le Corbusier (El viaje de Oriente
Desde la temprana fecha de 1911, en que realiza su viaje a Oriente, Le Corbusier nos muestra la capacidad mediadora que tiene la arquitectura para vincular los espacios, para conectar visualmente interior y exterior, para hacernos redescubrir la naturaleza acentuando nuestra percepción consciente. Sus dibujos sobre Villa Adriana, Pompeya, Atenas, etc., son un ejemplo de cómo percibir y plasmar en croquis su observación de la arquitectura y su ámbito exterior, de la captación del papel mediador entre arquitectura y lugar.
En sus textos posteriores, y especialmente en "Vers une architecture" (1923, así como a través de la experiencia de sus casas en los años veinte, nos mostrará el valor de las operaciones que acotan, enmarcan y proporcionan una dimensión de los espacios y del paisaje. Lo que hace de manera explícita y precisa en el texto "Une petite maison" (1923.
Alvar Aalto y, posteriormente, Álvaro Siza, recogerán esta capacidad de mediación entre arquitectura y lugar, buscando estimular la mirada para alentar la consciencia y el goce de los espacios y de la naturaleza. Las estrategias de la visión que proponen, sobre todo en el último caso, lo llegan a emparentar con el compromiso de enseñarnos a mirar y experimentar del Land Art.
Más allá de las imágenes expresivas y del lenguaje se tratará de ver, mediante ejemplos concretos, como la arquitectura se configura como vehículo de una percepción renovada y alentadora de los espacios y del lugar.
percepción, arquitectura, mediación, lugar, espacio
"Having educated my eyes in the spectacle of things, I try to tell you what I have found beautiful." Le Corbusier (The
Full Text Available Background. Although the usefulness of capsule endoscopy (CE and double-balloon endoscopy (DBE for the evaluation of Crohn’s disease (CD is established, their capabilities in the differential diagnosis of small bowel stenosis have not been sufficiently addressed. The present study therefore aimed to retrospectively determine the types of patients for whom CE and DBE would confer the most benefit. Patients and Methods. We retrospectively reviewed data from 185 patients with established CD. A change of treatment based on CE or DBE results or successful DBE balloon dilation was defined as clinically useful indication. We then analyzed the factors significantly related to useful and poor indications. Results. CE results were assessed as useful indications in 28 (45% of 62 patients. Multivariate analysis demonstrated that positive CRP and low IOIBD score are factors significantly related to a useful indication. DBE results were recognized as useful indications in 118 (77% of 153 patients. Multivariate analysis indicated small bowel stenosis and abdominal pain as factors significantly associated with useful indications. All patients with a poor indication on CE had small bowel stenosis. Conclusions. CE was most useful for patients in clinical remission with positive CRP and without stenosis, whereas DBE was useful for patients with symptoms of stenosis.
Miguel Ángel Urrego
Full Text Available El artículo analiza el impacto de los cambios planetarios a partir de la desintegración de la URSS y la hegemonía neoliberal en las izquierdas de América Latina. De igual forma, la manera como circularon en nuestro continente el posmodernismo, la teoría poscolonial y los estudios subalternos, y lo que representaron para los proyectos de utopía social. Finalmente, el artículo aborda la experiencia de la Reial, colectivo de académicos del continente que buscan com- prender las experiencias de las izquierdas; se propone desde allí, refundar las tradiciones utópicas de Latinoamérica.
Full Text Available Este artículo estudia la influencia del concepto de experiencia que desarrolla Robert Warshow. Warshow ha supuesto el contrapunto americano a las teorías desarrolladas por Walter Benjamien en Europa. Si bien ambos insistieron en la pobreza de la experiencia, como resultado de la tecnificación de la sociedad, Warshow supo introducir matizaciones que influyeron en todo el círculo de intelectuales concentrados en Nueva York durante la etapa de consolidación de los Estudios Culturales. This paper studies the influence of the experience concept by Robert Warshow. Warshow is the American counterpoint to theories developed by Walter Benjamin in Europe. Although both insisted in the poverty of experience, as a result of technique, Warshow knew how to introduce nuances that influenced intellectuals in New York as Cultural Studies emerged.
Salazar Vargas, Wilde María
Ubicación en Biblioteca USB Medellín (San Benito): CD-3054t.--Grupo de Investigación en Estudios Interdisciplinarios sobre Educación (ESINED).-- Linea de investigación: Educación Artística, Cultural y Patrimonio.--Área: artística.--Tema: formación La contemporaneidad (Barilli. 1998). Época histórica o movimiento artístico que instaura, y actualiza la experiencia, la subjetividad y con ella, el método de las ciencias empíricas e inductivas, en una relación simbiótica. Desde la experiencia h...
Full Text Available La química,dentro de la cual se incluye la electroquímica,es una materia que los estudiantes suelen ver como complicada, aburrida, carente de interés y que, además requiere de material de laboratorio sofisticado y reactivos químicos inaccesibles.Nada más lejos de la realidad,tal y como se pondrá de manifiesto en este trabajo,donde seproponen varias experiencias sencillas usando sustancias baratas,la mayoría de las cuales pueden encontrarse en un supermercado,y utensilios de cocina.Estas experiencias permiten abordar la electroquímica de una forma amena y divertida, despertando el interés de los alumnos por la química,en general,y por la electroquímica,en particular.
Miquel Àngel Alegre
Full Text Available El artículo aborda las experiencias vividas por los alumnos inmigrados durante los primeros momentos de su incorporación a los centros educativos de la sociedad de acogida. A partir del trabajo etnográfico realizado en seis institutos catalanes (49 entrevistas a alumnos inmigrados, los autores muestran las implicaciones de estas experiencias a dos niveles: en el terreno relacional y en el ámbito académico. Los extrañamientos iniciales ante un sistema educativo desconocido, la conformación de redes relacionales, el peso de las variables lingüísticas, o el papel jugado por los espacios educativos y relacionales de los centros son algunas de las cuestiones aquí tratadas.
Full Text Available Las áreas metropolitanas se han convertido en lugares en los que tienen lugar algunos de los mayores desafíos para el gobierno de nuestras sociedades (desigualdades sociales y territoriales, desarrollo económico, la diversidad étnica y cultural, la preservación del medio ambiente, etc.. Sin embargo, a pesar de su relevancia como espacios para el tratamiento de estos problemas, las áreas metropolitanas tienen grandes dificultades para transformarse en territorios políticos, es decir, para alcanzar un nivel de agente político suficiente (como actor colectivo para producir políticas adecuadas que aborden estos problemas y produzcan estrategias colectivas que orienten su desarrollo futuro. Para tratar este tema, este artículo se centrará en primer lugar en los principales obstáculos que les impiden alcanzar el nivel de actor político, que son comunes a la mayoría de los países europeos: la resistencia del Estado a otorgar a estos territorios las funciones y recursos adecuados en el proceso de descentralización y su preferencia por el reforzamiento de los niveles de gobierno existentes; la oposición de estos niveles de gobierno y la falta de apoyo de la sociedad civil (actores económicos y población. En un segundo apartado, este artículo presentará diferentes experiencias que han tenido lugar en la última década para superar estos obstáculos. Centrándose en la pacificación de las relaciones de poder a nivel metropolitano mediante conferencias, cartas y pactos metropolitanos y “políticas procedimentales” como la planificación estratégica, el autor considera que estas experiencias no parecen ofrecer potencialidades para la reducción del conflicto político entre actores y concluye con un tono pesimista sobre la gobernabilidad de las áreas metropolitanas.Metropolitan areas have become places where some of the major issues and stakes for the government of our societies are taking place (social and territorial
Flore, Giovanni; Pozzoni, Alfio
Este artículo aborda la experiencia lumínica en la ciudad inteligente y digital o, dicho de otro modo, el uso, cada vez mayor, de la digital signane visual en el entorno urbano, al aire libre y en lugares públicos. La investigación se centra en las áreas de la ciudad donde esta "contaminación" digital goza de mayor visibilidad y accesibilidad, es decir, las zonas comerciales.
Inés de Cassagne
Full Text Available Camus encuentra en el género trágico un cauce adecuado para su experiencia. Esta experiencia, cuya savia alimenta todos sus frutos literarios, es la del doble rostro de la existencia humana en este mundo. A ella responde como artista, y como hombre, en el perfecto equilibrio del “rechazo” y el “consentimiento”. Cuando decide en 1956 publicar su primer testimonio juvenil, El revés y el derecho, al prologarlo, confirma aquel testimonio y expone su decisión artística. Cambiar la vida, sin cambiar el mundo. Cambiar la miseria, sin cambiar el sol, la belleza, mediante la fórmula de equilibrio de “rechazo” y “consentimiento”.Esta fórmula no podría cuajar de modo acabado sino en el cauce de la tragedia, herencia de los griegos. Para quien revive la experiencia del destino humano en un mundo sin más allá, la sola trascendencia posible de perfectibilidad sólo puede darse en el espacio ideal del arte, único capaz de acoger dramáticamente la tensión entre los polos contrastantes la vida que colma y a la vez decepciona y pasa.
Full Text Available En el espacio de un dialogo aquí iniciado con la corriente de didáctica profesional este texto se propone restituir una dinámica intelectual que va del concepto de experiencia al concepto de actividad. Este último concepto parece necesitar lo que se considera como un drama en la experiencia humana (el debate de las normas y mostrar cómo la experiencia como sedimentación inestable de actividades es una matriz permanente de la historia. ¿Cuál puede ser entonces el precepto de los saberes generados por un ser así definido como ser de actividad? Se formulan verdaderos problemas epistemológicos en las relaciones entre las diversas formas del saber y las diversas formas de expresión en el lenguaje, como también para el precepto de los diversos saberes en su relación con la historicidad. Un problema no solo epistemológico sino también político pues podemos apreciar una cartografía de del precepto propio de las relaciones de saberes / poderes y aquellos a la deriva de la gobernanza del trabajo humano. Finalizamos tratando una problemática del , que pueda ser coherente con los patrimonios aquí reivindicados en la construcción del concepto ergológico de actividad.
George Herbert Mead
Full Text Available El texto que presentamos en este número de Athenea Digital es "La Naturaleza de la Experiencia Estética" escrito por G.H.Mead en 1926, traducido e introducido por Estaban Laso y Anna Vitores. Como los mismos traductores explican en la introducción que precede al texto de Mead: El artículo ?La Naturaleza de la Experiencia Estética? (1926 que presentamos en este mismo número ?y que como la inmensa mayoría de los escritos de Mead es muy breve? se inscribe dentro de la orientación hacia la crítica cultural de su obra tardía. En tanto que parte de la brecha entre la esfera instrumental y la de los valores que caracteriza a la actividad y al pensamiento humano en la sociedad moderna, ofrece una buena oportunidad para pensar acerca de la tensión meadiana entre creatividad y normatividad. Y quizás también, para ir más allá y reflexionar sobre la tensión entre cambio y reproducción social, y sobre las formas en que podríamos ofrecer un concepto de acción y de experiencia no individualistas que permitieran articular esta tensión.
Full Text Available Los museos son espacios educativos promisorios para el aprendizaje y la creatividad. En el artículo contamos experiencias vinculadas a la construcción de propuestas educativas en museos, entendidos como construcciones sociales. Específicamente, nos referimos a dos propuestas educativas: un museo construido en el aula y una visita a un museo fuera del aula. Nos interesa describir las propuestas desarrolladas haciendo especial hincapié en las percepciones y valoraciones de los estudiantes respecto de las potencialidades educativas de los museos. Participaron de las experiencias estudiantes de las carreras de Licenciatura en Psicopedagogía y Educación Especial de la Universidad Nacional de Río Cuarto. Los museos, construidos y visitados, generan espacios para aprender y vivenciar experiencias significativas de aprendizaje. También se observan impactos positivos de los museos en la promoción de la creatividad y el desarrollo de innovaciones educativas. Historias personales, grupales y sociales circulan por los museos configurando entornos propicios para construir conocimientos dentro y fuera de las aulas.
Zhiwei, Jia; Guozheng, Yan; Bingquan, Zhu
Wireless power transmission is considered a practical way of overcoming the power shortage of wireless capsule endoscopy (VCE). However, most patients cannot tolerate the long hours of lying in a fixed transmitting coil during diagnosis. To develop a portable wireless power transmission system for VCE, a compact transmitting coil and a portable inverter circuit driven by rechargeable batteries are proposed. The couple coils, optimized considering the stability and safety conditions, are 28 turns of transmitting coil and six strands of receiving coil. The driven circuit is designed according to the portable principle. Experiments show that the integrated system could continuously supply power to a dual-head VCE for more than 8 h at a frame rate of 30 frames per second with resolution of 320 × 240. The portable VCE exhibits potential for clinical applications, but requires further improvement and tests.
Divya Ann Jacob MBBS
Full Text Available Objective: Gastrointestinal endoscopy in children has become a standard diagnostic and therapeutic modality. The aim of our study was to characterize the most memorable elements of the patient experience from the parent’s and patient’s perspective and determine ways to improve the overall quality of their experience. Methods: Using a structured questionnaire, we conducted 47 phone interviews with families who had recently undergone gastrointestinal endoscopic procedures. Results: Our study showed clear communication and mutual agreement on care decisions contributed to positive experiences. Inadequate communication of information regarding alternatives to the procedure and risk of complications during the informed consent discussion contributed to negative patient experiences. Standardization of postprocedure follow-up and timely communication of pathology findings also had potential for improvement. Conclusion: Our study revealed 2 areas for quality improvement interventions: The need to ensure that alternatives and complications are thoroughly discussed and the need for standardization of postprocedure follow-up.
Louis; Harpham--Lockyer; Faidon--Marios; Laskaratos; Pasquale; Berlingieri; Owen; Epstein
Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simula-tors and the long-term benefits of their use are also discussed.
Shim, Dongha; Yeon, Jesun; Yi, Jason; Park, Jongwon; Park, Soo Nam; Lee, Nanhee
A wide-angle miniaturized camera module for disposable endoscope is demonstrated in this paper. A lens module with 150° angle of view (AOV) is designed and manufactured. All plastic injection-molded lenses and a commercial CMOS image sensor are employed to reduce the manufacturing cost. The image sensor and LED illumination unit are assembled with a lens module. The camera module does not include a camera processor to further reduce its size and cost. The size of the camera module is 5.5 × 5.5 × 22.3 mm3. The diagonal field of view (FOV) of the camera module is measured to be 110°. A prototype of a disposable endoscope is implemented to perform a pre-clinical animal testing. The esophagus of an adult beagle dog is observed. These results demonstrate the feasibility of a cost-effective and high-performance camera module for disposable endoscopy.
Rosenbusch, G.; Reeders, J.W.A.J.
This comprehensive reference work presents in-depth information on the diagnostic radiology and endoscopy of the colon. After a brief review of the history of colon examinations, two chapters explain the anatomy, physiology and pharmacology of the large intestine as well as the methods and techniques applied for radiological examination of the colon. The pathology and characteristical findings and the diagnostic evaluation of the various types of disease are the main subject, with the chapters discussing inflammations and tumors consuming by far most of the space, but there is also valuable information on vascular lesions, traumata, latrogenous or post-surgery lesions, among others, and on the characteristical findings in children. Numerous tables, radiographs and endoscopic images together with drawings illustrate and accompany the textbook information. (orig.). 492 figs., 95 tabs.
Slawinski, Piotr R; Obstein, Keith L; Valdastri, Pietro
Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review, we will discuss the state of the art, define the current shortcomings of capsule endoscopy, and address research areas that aim to overcome said shortcomings. Developments in capsule mobility schemes are emphasized in this text, with magnetic actuation being the most promising endeavor. Research groups are working to integrate sensor data and fuse it with robotic control to outperform today's standard invasive procedures, but in a less intrusive manner. With recent advances in areas such as mobility, drug delivery, and therapeutics, we foresee a translation of interventional capsule technology from the bench-top to the clinical setting within the next 10 years.
Dumonceau, Jean-Marc; Riphaus, Andrea; Schreiber, Florian
. Main Recommendations 1 We recommend that the type of endoscopic procedure and the patient's American Society of Anesthesiologists (ASA) physical status, age, body mass index, Mallampati's classification, and risk factors for obstructive sleep apnea (OSA) be assessed before each procedure with non...... deep sedation, and long procedures (weak recommendation, high quality evidence). 4 We suggest propofol monotherapy except in particular situations (weak recommendation, high quality evidence). 5 We recommend administering propofol through intermittent bolus infusion or perfusor systems, including...... evidence). 7 We do not suggest using pharyngeal anesthesia during propofol sedation for upper GI endoscopy (weak recommendation, moderate quality evidence). 8 We suggest using the post-anesthetic discharge scoring system (PADSS) to determine when patient recovery is sufficient to allow discharge (weak...
Harpham-Lockyer, Louis; Laskaratos, Faidon-Marios; Berlingieri, Pasquale; Epstein, Owen
Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simulators and the long-term benefits of their use are also discussed.
Galán Puchades, María Teresa
La carta al editor se refiere al artículo de Canaval-Zuleta et al. aceptado para publicación, titulado "Endoscopy as an alternative diagnostic and therapeutic technique for Taenia saginata". El trabajo presenta una serie de incorrecciones que deben ser aclaradas, o al menos parte de ellas en solo 300 palabras. La información sobre las vias de infeccion en taeniasis, así como la patogenia y técnicas de diagnóstico, no se ajustan a la realidad. Asimismo, ya está publicado que el diagnóstico por endoscopia es una técnica muy sensible pero nada específica, pues no permite distinguir entre las 3 especies humanas del género Taenia.
Full Text Available BACKGROUND: The accurate diagnosis of Chronic Rhinosinusitis (CRS is still a challenge therefore, the American Academy of Otorhinolaryngology - Head and Neck Surgery (AAO - HNS 1 has met in a multidisciplinary encounter and formulated a consensus based on only clinical symptoms. The computed tomography (CT scan and the nasal endoscopy (NE were introduced to make an accurate diagnosis of CRS and verify the disease severity. AIM: The aim of this study is to make a correlation between nasal endoscopy and CT scan in cases of clinically diagnosed Chronic Rhinosinusitis patients. METHOD: A study was carried out on 90 patients at Jhalawar Medical College, Jhalawar (Raj. during Sept. 20 12 to Dec. 2014. Diagnostic Nasal Endoscopy and CT Scan PNS done in patients, suffering from Chronic Rhinosinusitis. As a classification instruments, Metson / Gliklich's classification was used to evaluate the tomographic diagnosis and the Stankiewicz / Chow' s classification to evaluate the endoscopic diagnosis of Chronic Rhinosinusitis. RESULTS: Our study showed high specificity of endoscopy in comparison to CT scan though CT scan results are more sensitive. CONCLUSION: Endoscopy can confirm a Chronic Rhinosi nusitis diagnosis, but cannot rule it out, and that CT should be performed in cases of suspected CRS even if mucopurulence is not noted on endoscopy. The CT scan and the nasal endoscopy making easier the treatment planning and the disease resolution.
Bandorski, Dirk; Höltgen, Reinhard; Stunder, Dominik; Keuchel, Martin
According to the recommendations of the US Food and Drug Administration and manufacturers, capsule endoscopy should not be used in patients carrying implanted cardiac devices. For this review we considered studies indexed (until 30.06.2013) in Medline [keywords: capsule endoscopy, small bowel endoscopy, cardiac pacemaker, implantable cardioverter defibrillator, interference, left heart assist device], technical information from Given Imaging and one own publication (not listed in Medline). Several in vitro and in vivo studies included patients with implanted cardiac devices who underwent capsule endoscopy. No clinically relevant interference was noticed. Initial reports on interference with a simulating device were not reproduced. Furthermore technical data of PillCam (Given Imaging) demonstrate that the maximum transmission power is below the permitted limits for cardiac devices. Hence, impairment of cardiac pacemaker, defibrillator or left ventricular heart assist device function by capsule endoscopy is not expected. However, wireless telemetry can cause dysfunction of capsule endoscopy recording. Application of capsule endoscopy is feasible and safe in patients with implanted cardiac devices such as pacemakers, cardioverter defibrillators, and left heart assist devices. Development of new technologies warrants future re-evaluation.
Adriana Florentina CONSTANTINESCU
Full Text Available Wireless capsule endoscopy, the gold standard in the screening and diagnosis of small bowel diseases, is one of the most recent investigations for gastrointestinal pathology. This examination has the advantages of being non-invasive, painless, with a large clinical yield, especially for small bowel diseases, but also some disadvantages. The long time necessary for reading and interpreting all frames acquired is one of these disadvantages. This inconvenient could be improved through different methods by using software applications. In this study we have used a software application for texture analysis based on local binary pattern (LBP operator. This operator detects and removes non-informative frames in a first step, then identifies potential lesions. Our study group consisted of 33 patients from the Gastroenterology and Hepatology Centre Craiova and from the 1st Internal Medicine and Gastroenterology Clinic from the Emergency County Hospital of Craiova. The patients included in the study have corresponded to our inclusion criteria established. The exclusion criteria were represented by the contraindications of the capsule endoscopy. In the first phase of the study, we have removed the non-informative frames from the original videos obtained, and we have acquired an average reduction of 6.96% from the total number of images. In the second phase, using the same LBP operator, we have correctly identified 93.16% of telangiectasia lesions. Our study demonstrated that software applications based on LBP operator can lead to a shorter analysis time, by reducing the overall frames number, and can also provide support in diagnosis.
Varkey, Jonas; Oltean, Mihai; Pischel, Andreas Bernd; Simrén, Magnus; Herlenius, Gustaf
Background Intestinal transplantation is a procedure which inflicts immunological and infectious complications that affect the transplanted graft, posing both diagnostic and therapeutic challenges. Video capsule endoscopy (VCE) offers easy access to the entire small intestine and presents itself as an interesting option. However, at present, no studies evaluating the usefulness of video capsule endoscopies in this setting have been published. Our aim was to evaluate the usefulness of VCE in detecting complications that arise after intestinal transplantation. Methods We included 7 adult patients with either isolated intestine (n = 1) or multivisceral grafts (n = 6). These patients underwent 12 VCE between 2004 and 2015 at the Sahlgrenska University Hospital. The median age was 42 (21-67) years (4 women/3 men). VCE was used in clinical situations where the conventional diagnostic methods failed to provide answers to the clinical question. Results Indications for the procedure were: suspicion of rejection (n = 4 examinations), gastrointestinal dysmotility (n = 4 examinations), high stomal output (n = 2 examinations), suspicion of lymphoproliferative disease in the transplanted graft (n = 1 examination), and clinical surveillance (n = 1 examination). The median time after transplantation for performing an examination was 740 (26-3059) days. VCE was useful in 83% of the examinations and the results influenced the planned management. The overall agreement between VCE findings and biopsies was moderate (κ = 0.54, P = 0.05) but increased when comparing the presence of inflammation/rejection (κ = 0.79, P < 0.001). Conclusions VCE is a promising diagnostic method after intestinal transplantation. However, larger studies are needed to evaluate its potential risks and gains. PMID:27990484
Choi, Jong Hwan; Choi, Jae Hyuk; Lee, Yoo Jin; Lee, Hyung Ki; Choi, Wang Yong; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok
To compare outcomes using the novel portable endoscopy with that of nasogastric (NG) aspiration in patients with gastrointestinal bleeding. Patients who underwent NG aspiration for the evaluation of upper gastrointestinal (UGI) bleeding were eligible for the study. After NG aspiration, we performed the portable endoscopy to identify bleeding evidence in the UGI tract. Then, all patients underwent conventional esophagogastroduodenoscopy as the gold-standard test. The sensitivity, specificity, and accuracy of the portable endoscopy for confirming UGI bleeding were compared with those of NG aspiration. In total, 129 patients who had GI bleeding signs or symptoms were included in the study (age 64.46 ± 13.79, 91 males). The UGI tract (esophagus, stomach, and duodenum) was the most common site of bleeding (81, 62.8%) and the cause of bleeding was not identified in 12 patients (9.3%). Specificity for identifying UGI bleeding was higher with the portable endoscopy than NG aspiration (85.4% vs 68.8%, P = 0.008) while accuracy was comparable. The accuracy of the portable endoscopy was significantly higher than that of NG in the subgroup analysis of patients with esophageal bleeding (88.2% vs 75%, P = 0.004). Food material could be detected more readily by the portable endoscopy than NG tube aspiration (20.9% vs 9.3%, P = 0.014). No serious adverse effect was observed during the portable endoscopy. The portable endoscopy was not superior to NG aspiration for confirming UGI bleeding site. However, this novel portable endoscopy device might provide a benefit over NG aspiration in patients with esophageal bleeding.
Thorne, K.; Hutchings, H.A.; Elwyn, G.
BACKGROUND: The availability of routinely collected service-related endoscopy data from NHS endoscopy units has never been quantified. METHODS: This retrospective observational study asked 19 endoscopy units to submit copies of all in-house, service-related endoscopy data that had been routinely
Full Text Available Several organizations worldwide have developed procedure-based guidelines and/or position statements regarding various aspects of quality and safety indicators, and credentialing for endoscopy. Although important, they do not specifically address patient needs or provide a framework for their adoption in the context of endoscopy services. The consensus guidelines reported in this article, however, aimed to identify processes and indicators relevant to the provision of high-quality endoscopy services that will support ongoing quality improvement across many jurisdictions, specifically in the areas of ethics, facility standards and policies, quality assurance, training and education, reporting standards and patient perceptions.
Kjeldsen, Hans Christian; Lauritzen, Torsten; Christensen, Bo
Title: Clinical Efficacy of Proton Pump Inhibitor versus Prompt Endoscopy for Management of People with Dyspepsia: A Randomized Clinical Trial in General Practice. Purpose: To compare the clinical efficacy of two strategies for management of dyspepsia in general practice in a RCT design....... Setting: June 2000 to August 2002, 41 GPs, Aarhus County, Denmark Methods: 368 people with dyspepsia (epigastric pain/discomfort, no alarm symptoms) were randomly assigned to treatment with omeprazol 40 mg/day for two weeks (PPI group, n:185) or endoscopy (endoscopy group, n:183). Due to migration......, dyspeptic contacts to GP or patients' satisfaction. Conclusions: Prompt endoscopy was superior to proton pump inhibitor concerning symptom improvement in management of dyspepsia in general practice when pain/discomfort was the primary symptom. There were no differences between the two strategies in respect...
Douglas B Nelson; Lawrence F Muscarella
The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field.
Hussain, Ikram; Ang, Tiing Leong
Gastric cancer is the third most common cause of cancer-related death. Advanced stages of gastric cancers generally have grim prognosis. But, good prognosis can be achieved if such cancers are detected, diagnosed and resected at early stages. However, early gastric cancers and its precursors often produce only subtle mucosal changes and therefore quite commonly remain elusive at the conventional examination with white light endoscopy. Image-enhanced endoscopy makes mucosal lesions more conspicuous and can therefore potentially yield earlier and more accurate diagnoses. Recent years have seen growing work of research in support of various types of image enhanced endoscopy (IEE) techniques (e.g., dye-chromoendoscopy; magnification endoscopy; narrow-band imaging; flexible spectral imaging color enhancement; and I-SCAN) for a variety of gastric pathologies. In this review, we will examine the evidence for the utilization of various IEE techniques in the diagnosis of gastric disorders. PMID:28042388
Gómez, N A; León, C J; Gutiérrez, J
Otilonium bromide is a calcium antagonist with a direct myolytic effect, that is indicated in spastic conditions and functional dyskinesias of the gastroenteric apparatus (irritable bowel syndrome) and as a premedication for gastrointestinal endoscopic procedures. The present study assessed otilonium bromide 40 mg PO the night before and 40 mg PO the morning in 49 upper and 14 lower flexible endoscopies in 63 patients, to determine the presence or absence of peristalsis and relaxation of the pylorus. No side effects were observed due to the medication. In 46 (93.8%) upper endoscopies marked relaxation of the gastrointestinal tract and also pylorus relaxation were observed. In 13 (92.8%) lower endoscopies, marked relaxation of the colonic tract was also seen. All patients tolerated well the endoscopies. Otilonium bromide was useful as premedication in order to enable upper and lower endoscopic explorations, because of its spasmolytic effect.
Full Text Available BACKGROUND: Capsule endoscopy (CE is a valuable tool in the diagnostic evaluation of obscure gastrointestinal bleeding, but limited information is available on the reproducibility of CE findings.
Gawron, Andrew J; Yadlapati, Rena
It is well established that disparities exist for colorectal cancer (CRC) incidence rates and death. With screening, death from CRC may be considered a preventable occurrence. Endoscopy (flexible sigmoidoscopy and colonoscopy) is the only modality with therapeutic benefit of removal of pre-cancerous polyps. The Patient Protection and Affordable Care Act mandated that preventive screening services be covered, which includes endoscopy for colon cancer screening. Recent federal rules have eliminated cost sharing for polyp removal during screening colonoscopy in privately insured patients; however, this has not been mandated for Medicare patients. Understanding the current state of disparities in endoscopy use is important, as these policy changes will affect millions of patients. The purpose of this literature review was to summarize the known research on disparities in endoscopy use for colon cancer screening in the United States and highlight areas for future research.
Cho, Soo-Han; Lee, Yoon-Seon; Kim, Youn-Jung; Sohn, Chang Hwan; Ahn, Shin; Seo, Dong-Woo; Kim, Won Young; Lee, Jae Ho; Lim, Kyoung Soo
We investigated clinical outcomes in high-risk patients with acute nonvariceal upper gastrointestinal bleeding (UGIB), and determined if urgent endoscopy is effective. Consecutive patients with a Glasgow-Blatchford score greater than 7 who underwent endoscopy for acute nonvariceal UGIB at the emergency department from January 1, 2005, to December 31, 2014, were included. Urgent (nonvariceal UGIB. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
Targownik, Laura E; Murthy, Sanjay; Keyvani, Leila; Leeson, Shauna
BACKGROUND: Performance of endoscopy within 24 h is recommended for patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). It is unknown whether performing endoscopy early within this 24 h window is beneficial for clinically high-risk patients. METHODS: A retrospective review was performed to identify patients presenting to two tertiary care centres with ANVUGIB and either systolic blood pressure lower than 100 mmHg or heart rate greater than 100 beats/min on presentation between 1999 and 2004. Patients receiving endoscopy within 6 h (rapid endoscopy [RE]) were compared with patients undergoing endoscopy between 6 h and 24 h (early endoscopy [EE]). The primary outcome measure was the development of any adverse bleeding outcome (rebleeding, surgery for control of bleeding, in-hospital mortality or readmission within 30 days for ANVUGIB). RESULTS: There were 169 patients who met the entry criteria (77 RE patients and 92 EE patients). There was no significant difference in the development of any adverse bleeding outcomes between RE and EE patients (25% RE versus 23% EE, difference between groups 2%, 95% CI −9% to 13%). Transfusion requirements and length of hospital stay also did not differ between the comparator groups. RE was not associated with fewer adverse outcomes, even after adjusting for confounders. CONCLUSION: For clinically high-risk ANVUGIB patients, performing endoscopy within 6 h of presentation is no more effective than performing endoscopy between 6 h and 24 h after presentation. The role of RE in high-risk ANVUGIB patients requires further delineation in a prospective fashion. PMID:17637943
Sidhu, R; Sanders, D S; McAlindon, M E; Thomson, M
Historically the small bowel has been considered a technically difficult area to examine because of its length (3-5 metres), location and tortuosity. Capsule endoscopy and enteroscopy have revolutionised the investigation pathway of the small bowel in adults. They are now developing increasingly important roles as modalities of investigation in paediatrics. This review appraises the current literature to define the clinical indications and practical aspects of capsule endoscopy and enteroscopy that are of interest to the clinician.
Fanucci, Ezio; Leporace, Mario; Di Costanzo, Giuseppe; Mannino, Michela; Simonetti, Giovanni
The use of CT scans in dental pathology is an established technique. The potential applications of Dentascan are further enhanced by the use of virtual navigation software, resulting in endoscopy-like imaging of the maxillary sinus, thus optimising both the diagnostic and therapeutic approach to sinus pathology of dental origin. The aim of this paper is to illustrate the technical-methodological aspects of maxillary sinus virtual endoscopy with Dentascan software and to document the most important and frequent diseases.
Full Text Available Abstract Background Upper gastrointestinal endoscopy is the most preferable diagnostic examination for patients over fifty when upper gastrointestinal symptoms appear. However, limited knowledge exists in concerns to the compliance of primary care patients' to the doctors' recommendations for endoscopy. Methods Patients who visited primary care practices in Greece and experienced upper gastrointestinal symptoms within a 10 days screening study, were referred for an upper endoscopy exam. The patients which refused to complete the endoscopy exam, were interviewed by the use of an open- ended translated and validated questionnaire, the Identification of Dyspepsia in General Population (IDGP questionnaire. A qualitative thematic analysis grounded on the theory of planned behavior was performed to reveal the reasons for patients' refusal, while socio-demographic predictors were also assessed. Results Nine hundred and ninety two patients were recorded, 159 of them (16% were found positive for dyspepsia and gastro-esophageal reflux disease according to the IDGP questionnaire. Out of the above, 131 (83.6% patients refused further investigation with endoscopy. Patients who refused upper endoscopy were predominantly female (87.8% (p = 0.036 and over the age of 50. The lack of severe symptoms, fear of pain, concerns of sedation, comorbidity and competing life demands were reported by patients as barriers to performing an endoscopic investigation. Conclusions Patients with dyspepsia in rural Greece tend to avoid upper gastrointestinal endoscopy, with two major axons considered to be the causes of patients' refusal: their beliefs towards endoscopy and their personal capability to cope with it. Future research examining reasons of low compliance should be carried out in combination with modern behavioral theories so as to investigate into the above.
Full Text Available BACKGROUND: Wait times are an important measure of health care system effectiveness. There are no studies describing wait times in pediatric gastroenterology for either outpatient visits or endoscopy. Pediatric endoscopy is performed under light sedation or general anesthesia. The latter is hypothesized to be associated with a longer wait time due to practical limits on access to anesthesia in the Canadian health care system.
Heo, Hyun Mi; Park, Chan Hyuk; Lee, Jin Ha; Kim, Bo Kyung; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho; Hong, Sung Pil [Yonsei University College of Medicine, Department of Internal Medicine and Institute of Gastroenterology, Seoul (Korea, Republic of); Lim, Joon Seok [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea, Republic of)
The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography. We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%. Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy. Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography. circle CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). circle Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. circle Negative CT enterography does not exclude important causes of small bowel bleeding. circle Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy. (orig.)
戈之铮; 胡运彪; 萧树东
Background In obscure gastrointestinal (GI) bleeding, it is often difficult to detect the bleeding sites located in the small bowel with conventional radiological, scintigraphic or angiographic techniques. Push enteroscopy and capsule endoscopy are currently considered to be the most effective diagnostic procedures. The aim of this study was to compare the detection rates between capsule endoscopy and push enteroscopy. Methods From May 2002 through January 2003, we prospectively examined by capsule endoscopy 39 patients with suspected small bowel diseases, in particular GI bleeding of unknown origin in Renji Hospital. Among them, 32 complained of obscure recurrent GI bleeding. Between January 1993 and October 1996, we used push enteroscopy on 36 patients who suffered from unexplained GI bleeding. All patients had prior normal results on gastroscopy, colonoscopy, small bowel barium radiography, scintigraphy and/or angiography. Results M2A capsule endoscopy disclosed abnormal small bowel findings in 26 (82%) out of 32 patients. Twenty-one of them had significant pathological findings explaining their clinical disorders. Diagnostic yield was therefore 66% (21 of 32 patients). Definite bleeding sites diagnosed by capsule endoscopy in 21 patients included angiodysplasia (8), inflammatory small-bowel (5), small-bowel polyps (4), gastrointestinal stromal tumour (2), carcinoid tumour and lipoma (1), and hemorrhagic gastritis (1). Push enteroscopy detected the definite sources of bleeding in 9 (25%) of the 36 patients. Patients with definite bleeding sources included angiodysplasias (2), leiomyosarcoma (2), leiomyoma (1), lymphoma (1), Crohn's disease (1), small-bowel polyps (1) and adenocarcinoma of ampulla (1). Suspected bleeding sources were shown by push enteroscopy in two additional patients (6%), and in other five patients (16%) by capsule endoscopy.Conclusions The present study of patients with obscure GI bleeding showed that capsule endoscopy significantly superior
Wireless capsule endoscopy (WCE) is a promising technology for direct diagnosis of the entire small bowel to detect lethal diseases, including cancer and obscure gastrointestinal bleeding (OGIB). To improve the quality of diagnosis, some vital specifications of WCE such as image resolution, frame rate and working time need to be improved. Additionally, future multi-functioning robotic capsule endoscopy (RCE) units may utilize advanced features such as active system control over capsule motion...
The influence of personality traits on the reaction of patients to upper gastrointestinal endoscopy was studied prospectively in 86 patients. High N (neuroticism) scores on the Eysenck personality inventory were associated with poor tolerance to and future compliance with the procedure. Although premedication with diazepam did not affect the degree of discomfort and distress during the procedure, it guaranteed acceptance of repeat endoscopy by virtue of its strong amnesic effect. By contrast,...
Matthieu; Allez; Marc; Lémann
Endoscopy provides a direct evaluation of mucosal lesions in inflammatory bowel disease(IBD),permitting the description of elementary lesions,their surface extent and severity.The severity of mucosal lesions directly reflects disease activity and may help to identify an aggressive behavior of the disease.Several studies have recently pointed out the potential role of endoscopy in the prediction of IBD outcome.Indeed,severe endoscopic lesions in Crohn's disease(CD) patients,defined by deep and extensive ulce...
Lightdale, Jenifer R; Mitchell, Paul D; Fredette, Meghan E.; Mahoney, Lisa B.; Zgleszewski, Steven E.; Lisa Scharff; Fox, Victor L
Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ...
Jairath, V; Kahan, B C; Logan, R F A; Hearnshaw, S A; Doré, C J; Travis, S P L; Murphy, M F; Palmer, K R
Despite the established efficacy of therapeutic endoscopy, the optimum timeframe for performing endoscopy in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) remains unclear. The aim of the current audit study was to examine the relationship between time to endoscopy and clinical outcomes in patients presenting with NVUGIB. This study was a prospective national audit performed in 212 UK hospitals. Regression models examined the relationship between time to endoscopy and mortality, rebleeding, need for surgery, and length of hospital stay. In 4478 patients, earlier endoscopy ( 24 hours) endoscopy (odds ratio [OR] for mortality 0.98, 95 % confidence interval [CI] 0.88 - 1.09 for endoscopy > 24 hours vs. 24 hours vs. 24 hours vs. 24 hours) was associated with an increase in risk-adjusted length of hospital stay (1.7 days longer, 95 %CI 1.39 - 1.99 vs. < 12 hours; P < 0.001). Earlier endoscopy was not associated with a reduction in mortality or need for surgery. However, it was associated with an increased efficiency of care and potentially improved control of hemorrhage in higher risk patients, supporting the routine use of early endoscopy unless specific contraindications exist. These results may help inform the debate about emergency endoscopy service provision. © Georg Thieme Verlag KG Stuttgart · New York.
European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy
Dumonceau, J.M.; Riphaus, A.; Aparicio, J.R.
Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this evi...
European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anaesthesiologist administration of propofol for GI endoscopy
Dumonceau, J.M.; Riphaus, A.; Aparicio, J.R.
Propofol sedation by non-anaesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this ev...
Mohammed Y Hasosah
Full Text Available Background/Aim: Eosinophilic esophagitis (EE is a clinicopathologic entity characterized by esophageal symptoms in association with a dense eosinophilic infiltrate currently defined as >15 eosinophils per high power field in the appropriate clinical context. This is the first pediatric study in Saudi Arabia to give the experience with EE and examine its symptom, histology and endoscopy results. Materials and Methods: Retrospective chart review of all patients diagnosed with EE at National Guard Hospital, Jeddah Between 2007 and 2009. The authors identified EE on histologic criteria (≥15 eosinophils per high-power field together with their clinical context. The authors reviewed medical records for details of clinical presentation, laboratory data, radiologic, endoscopic, and histologic findings, and the results of treatment. Results: We identified 15 patients in our database in the last three years. 100% of the patients were males. The median age at presentation was 10 years (range, 3-17 years. The commonly reported symptoms were failure to thrive (86%, epigastric abdominal pain (53%, poor eating (40%, dysphagia with solid food (26%, food impaction (13%, and vomiting (20%. Asthma was reported in 46% and allergic rhinitis in 40%. Peripheral eosinophilia (>0.7 Χ 10/l was found in 66%. High serum IgE Level (>60 IU/ml was found in 60%. Upper endoscopic analysis revealed esophageal trachealization in 46%, esophageal erythema in 46%, white specks on the esophageal mucosa in 33%, esophageal narrowing in 13%, and normal endoscopy in 13%. The mean eosinophils per high-power field was 30.4 (range, 20-71. Histologic characteristics included degranulated eosinophils (86%, basal cell hyperplasia (93% and eosinophils clusters (micro-abscess in 73%. The treatment of EE revealed that they used swallowed corticosteroid in 50%, proton pump inhibitors in 66%, elemental diet/ food elimination in 13% and systemic corticosteroid in 13%. Conclusions: Failure to
José; Cotter; Francisca; Dias; de; Castro; Joana; Magalhes; Maria; Joo; Moreira; Bruno; Rosa
AIM:To evaluate whether the use of real time viewer(RTV)and administration of domperidone to patients with delayed gastric passage of the capsule could reduce the rate of incomplete examinations(IE)and improve the diagnostic yield of small bowel capsule endoscopy(SBCE).METHODS:Prospective single center interventional study,from June 2012 to February 2013.Capsule location was systematically checked one hour after ingestion using RTV.If it remained in the stomach,the patient received 10 mg domperidone per os and the location of the capsule was rechecked after 30 min.If the capsule remained in the stomach a second dose of10 mg of domperidone was administered orally.After another 30 min the position was rechecked and if the capsule remained in the stomach,it was passed into the duodenum by upper gastrointestinal(GI)endoscopy.The rate of IE and diagnostic yield of SBCE were compared with those of examinations performed before the use of RTV or domperidone in our Department(control group,January 2009-May 2012).RESULTS:Both groups were similar regarding age,sex,indication,inpatient status and surgical history.The control group included 307 patients,with 48(15.6%)IE.The RTV group included 82 patients,with3(3.7%)IE,P=0.003.In the control group,average gastric time was significantly longer in patients with IE than in patients with complete examination of the small bowel(77 min vs 26 min,P=0.003).In the RTV group,the capsule remained in the stomach one hour after ingestion in 14/82 patients(17.0%)vs 48/307(15.6%)in the control group,P=0.736.Domperidone did not significantly affect small bowel transit time(260min vs 297 min,P=0.229).The capsule detected positive findings in 39%of patients in the control group and 49%in the RTV group(P=0.081).CONCLUSION:The use of RTV and selective administration of domperidone to patients with delayed gastric passage of the capsule significantly reduces incomplete examinations,with no effect on small bowel transit time or diagnostic yield.
Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F.; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision. ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients. PMID:26966520
Xiao, Dinghua; Wang, Fen; Wang, Xiaoyan; Tang, Wuliang; Ouyang, Wen; Shen, Shourong
To explore the application of propofol combined with midazolam intravenous anesthesia in pediatric upper gastrointestinal endoscopy. A total of 497 ASA I~II patients who received sedative upper gastrointestinal endoscopy were assigned to a children group (2-14 years) and an adults group (18-65 years).The 2 groups were treated with midazolam (0.02-0.03 mg/kg, iv) and propofol(0.6-0.7 mg/s,iv) with an interval of 3-5 minutes. Enterscopy was inserted at light sleep, relaxing muscles, and disappearance of eyelash relaxation. Combining of pro-endoscopy, reaction to intravenous administration, dose of propofol, reaction to endoscopy, time of returning to consciousness, changes of SpO2, R, HR, and BP, and sedative quality were evaluated. Good sedation of the 2 groups after intravenous administration was observed. Rate of combining of pro-endoscopy in children was lower (42%) than that in adults(100%). The incidence of restlessness, hyperphasia, temporary decreasing of SpO2, dose of propofol of per kilogram weight, time of returning to consciousness in the children were 82.7%, 17%, 2.4 mg/kg, and (17.5+/-3.2) min, respectively, which were all higher in the adults [9%, 4%, 1.4 mg/kg, and (9.5+/-1.3) min, P0.05). It is safe and effective to use propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy.
Full Text Available CONTEXT: The prevalence of obesity has been increasing in modern society. Roux-en-y gastric bypass is a bariatric surgery that involves the exclusion of significant part of the stomach. Atrophy, intestinal metaplasia and gastric cancer have been associated with infection by Helicobacter pylori. OBJECTIVES: To evaluate the presence of endoscopy findings and histological changes in morbid obese patients for the presence of inflammatory cells, inflammatory activity, lymphoid hyperplasia, H. pylori infection, atrophy and intestinal metaplasia in the gastric mucosa. METHODS: Upper digestive endoscopy and gastric histopathological were studied in 126 obese patients in the preoperative evaluation for bariatric surgery. RESULTS: Upper digestive endoscopy abnormalities were diagnosed in 73/126 (57.9% patients. In three patients (2.4% the upper gastrointestinal endoscopy diagnosed gastric ulcer and one patient (0.8% had duodenal ulcer. The histopathological from gastric biopsies of these obese patients showed 65.1% of mucosa inflammation, inflammatory activity in 50.0%, infection by H. pylori in 53.2%, lymphoid hyperplasia in 50.0% and atrophy and/or intestinal metaplasia in 16.7%. CONCLUSIONS: In present study, with routine preoperative upper gastrointestinal endoscopy and histopathological examination, were detected 57.9% patients with endoscopy abnormalities, high prevalence of infection by H. pylori (53% and 16.7% of gastric atrophy and/or intestinal metaplasia.
Full Text Available Background: A suitable sedative status during gastro-enteric endoscopies results in better physicians′ approach and more stable view of internal organs. Therefore, we evaluated the effect of ketamine for sedation in endoscopic procedures of adult patients. Materials and Methods: Patients who were candidates for gastro-enteric endoscopy during the years 2014-2015 were included into the study and divided into two groups of case (administered 5 mg/kg of oral ketamine half an hour before initiation of the procedure and control (administered placebo in a same pattern. After endoscopy, patients and physicians′ satisfaction of sedation was assessed. SPSS-22 was used for data analysis. Results: Eighty-six patients participated into the study of which divided into each groups. The pain and discomfort scores were 2.4 ± 1.8 and 5.81 ± 1.48 in case and control groups, respectively, (P < 0.001. Mann-Whitney test revealed statistical difference among groups about physician′s satisfaction of sedation during endoscopy (P < 0.001. Patients who received ketamine had better sedative status (P < 0.001. None of the patients in the case group was completely awake but all of the patients in the control group were awake. The number of retching during endoscopy showed that individuals in the control group had more frequent retching episodes (P = 0.04. Conclusion: Low-dose oral administration of ketamine could make a satisfied sedation for gastro-enteric endoscopy.
Staníková, L; Šatanková, J; Kučová, H; Walderová, R; Zeleník, K; Komínek, Pavel
The aim of this study was to investigate whether observing microvascular changes by narrow-band imaging (NBI) endoscopy in the area surrounding leukoplakia is sufficient for discriminating between benign and malignant patterns of vocal cord leukoplakia. A total of 282 patients were investigated using white-light high-definition TV laryngoscopy and NBI endoscopy from 6/2013 to 8/2015, and 63 patients with a primary case of laryngeal leukoplakia were enrolled. Patients were divided into two groups based on leukoplakia with surrounding malignant intraepithelial papillary capillary loops (group I; 26/63) and leukoplakia with a surrounding benign vascular network (group II; 37/63), both by NBI endoscopy. All 63 patients were evaluated by blinded histological examination, and results were compared with NBI optical biopsy. Carcinoma in situ or invasive squamous cell carcinoma was confirmed in 22/26 cases (84.6 %) in group I. Hyperkeratosis or low-grade dysplasia was confirmed histologically in 31/37 (83.8 %) and squamous cell carcinoma in 2/37 (5.4 %) cases in group II. Accordance of NBI endoscopy and histopathological features of vocal cord leukoplakia lesions was statistically significant (kappa index 0.77, p leukoplakias based on optic prehistological diagnosis. The close accordance between NBI features and histological results suggests that a negative NBI endoscopy may be an indication for long-term endoscopy follow-up without histological evaluation.
Nam, Seung-Joo; Chun, Hoon Jai; Moon, Jeong Seop; Park, Sung Chul; Hwang, Young-Jae; Yoo, In Kyung; Lee, Jae Min; Kim, Seung Han; Choi, Hyuk Soon; Kim, Eun Sun; Keum, Bora; Jeen, Yoon Tae; Lee, Hong Sik; Kim, Chang Duck
The management of job-related stress among health-care workers is critical for the improvement of healthcare services; however, there is no existing research on endoscopy unit workers as a team. Korea has a unique health-care system for endoscopy unit workers. In this study, we aimed to estimate job stress and job satisfaction among health-care providers in endoscopy units in Korea. We performed a cross-sectional survey of health-care providers in the endoscopy units of three university-affiliated hospitals in Korea. We analyzed the job stress levels by using the Korean occupational stress scale, contributing factors, and job satisfaction. Fifty-nine workers completed the self-administered questionnaires. The job stress scores for the endoscopy unit workers (46.39±7.81) were relatively lower compared to those of the national sample of Korean workers (51.23±8.83). Job stress differed across job positions, with nurses showing significantly higher levels of stress (48.92±7.97) compared to doctors (42.59±6.37). Job stress and job satisfaction were negatively correlated with each other (R (2) =0.340, pstress and job satisfaction significantly differ according to job positions. Job demand, insufficient job control, and job insecurity are the most important stressors in the endoscopy unit.
Pezzoli, Alessandro; Cannizzaro, Renato; Pennazio, Marco; Rondonotti, Emanuele; Zancanella, Laura; Fusetti, Nadia; Simoni, Marzia; Cantoni, Franco; Melina, Raffaele; Alberani, Angela; Caravelli, Giancarlo; Villa, Federica; Chilovi, Fausto; Casetti, Tino; Iaquinto, Gaetano; D'imperio, Nicola; Gullini, Sergio
Few studies have specifically addressed interobserver agreement in describing lesions identified during capsule endoscopy. The aim of our study is to evaluate interobserver agreement in the description of capsule endoscopy findings. Consecutive short segments of capsule endoscopy were prospectively observed by 8 investigators. Seventy-five videos were prepared by an external investigator (gold standard). The description of the findings was reported by the investigators using the same validated and standardized capsule endoscopy structured terminology. The agreement was assessed using Cohen's kappa statistic. As concerns the ability to detect a lesion, the agreement with the gold standard was moderate (kappa 0.48), as well as the agreement relating to the final diagnosis (κ 0.45). The best agreement was observed in identifying the presence of active bleeding (κ 0.72), whereas the poorest agreement concerned the lesion size (κ 0.32). The agreement with the GS was significantly better in endoscopists with higher case/volume of capsule endoscopy per year. Diagnostic concordance was better in the presence of angiectasia than in the presence of polyps or ulcers/erosions. Correct lesion identification and diagnosis seem more likely to occur in presence of angiectasia, and for readers with more experience in capsule endoscopy reading. Published by Elsevier Ltd.
Full Text Available El articulo recoge algunas reflexiones en tormo al trabajode campo realizado con mujeres excombatientes de diversos grupos armados colombianos en el marco de la investigación Mujeres en tiempos de guerra: una mirada a lo femenino en el contexto de los grupos armados colombianos. A partir de una concepción de la guerra como construcción cultural, las autoras interrogan los efectos de la misma sobre su identidad femenina, esto es, lo que la guerra ha representado para ellas como mujeres y los efectos que ha tenido en términos de su identidad genérica. Tras una reflexión inicia en torno a los desafíos éticos planteados por el trabajo de campo, las autoras abordan la problemática de la identidad de género a través de dos vías: por una parte, los campos o "nudos¿ temáticos que amarran las narraciones de mujeres entrevistadas -la familia, la maternidad y los hijos, las relaciones con los "otros", las experiencias de muerte y el dolor de la guerra-; y por otra, la forma particular en que ellas construyen sus relatos sobre su experiencia como combatientes. Por último, a partir de esa mirada analítica sobre la manera como estas mujeres han vivido y significado su experiencia como guerreras, las autoras plantean, algunas conclusiones preliminares en torno a dicha problemática.
Fernanda Daniela Oyarzo
Full Text Available La TV Digital es una tecnología, que va a transformar la experiencia de ver televisión. Imagen y sonido en alta definición junto con la interactividad son posibles gracias al pasaje de la transmisión analógica a la digital, la cual permite enviar datos, video, audio, aplicaciones, etc. a través de los canales de transmisión. Estas señales digitales son más eficientes que las analógicas y tienen como principal ventaja la posibilidad de enviar servicios a través del mismo canal, permitiendo un uso eficiente del espectro de transmisiones. Emergen nuevas posibilidades para el desarrollo de software, puesto que una aplicación interactiva de TV Digital es un software, específicamente una aplicación multimedia a través de la cual el televidente puede interactuar vía control remoto. Esto significa que el televidente también puede recibir video/audio, software que posibilitan que interactúe con el contenido vinculado. En estos nuevos escenarios resulta necesario llevar adelante experiencias de desarrollo de aplicaciones interactivas para TV Digital. Poner en práctica procesos, estrategias y herramientas, y su consecuente análisis promete arribar a propuestas razonables. En este sentido, este trabajo condensa las experiencias en el desarrollo de prototipos realizados en el Laboratorio de TV Digital de la UNPA que se iniciaron en el año 2011.
Full Text Available El artículo recoge algunas reflexiones en torno al trabajo de campo realizado con mujeres excombatientes de diversos grupos armados colombianos en el marco de la investigación Mujeres en tiempos de guerra: una mirada a lo femenino en el contexto de los grupos armados colombianos. A partir de una concepción de la guerra como construcción cultural, las autoras interrogan los efectos de la misma sobre su identidad femenina, esto es, lo que la guerra ha representado para ellas como mujeres y los efectos que ha tenido en términos de su identidad genérica. Tras una reflexión inicial en torno a los desafíos éticos planteados por el trabajo de campo, las autoras abordan la problemática de la identidad de género a través de dos vías: por una parte, los campos o “nudos” temáticos que amarran las narraciones de las mujeres entrevistadas –la familia, la maternidad y los hijos, las relaciones con los “otros”, las experiencias de muerte y el dolor de la guerra-; y por otra parte, la forma particular en que ellas construyen sus relatos sobre su experiencia como combatientes. Por último, a partir de esa mirada analítica sobre la manera como estas mujeres han vivido y significado su experiencia como guerreras, las autoras plantean algunas conclusiones preliminares en torno a dicha problemática.
Experiencia interdisciplinar que abarca las asignaturas de historia, matemáticas, castellano, educación artística, música, cnntabilidad y educación cívica, basada en la dramatización y expresión corporal. Las matemáticas actúan como parte activa e integradora. Se llevó a cabo en Argentina con alumnos del primer ciclo del secundario (12-13 años) durante todo el curso.
Margarita R. Rodríguez-Gallego; Rosario Ordóñez-Sierra
Esta investigación describe la experiencia de Aprendizaje-Servicio vivida y desarrollada por 100 estudiantes-servicio de la Universidad de Sevilla, que participaron voluntariamente durante el curso académico 2013-2014y 104 profesionales de centros educativos. Entre los objetivos, valorar el grado de satisfacción de los participantes en el proyecto ApS y conocer supercepcióncomo futurosdocentes. El diseño de la investigación ha sido mixto, por una parte, exploratorio y no exp...
Jorge Díaz Tejeda
Este artículo propone Premisas Conceptuales, Premisas Metodológicas y el desarrollo de Aspectos Estratégicos para la implementación de soluciones a la Movilidad Urbana. Se inspira en las ideas, experiencias e investigaciones de diversas personas quienes abordan desde lógicas puntuales aspectos temáticos específicos en el marco de la Planificación Urbana en general y de las aplicaciones en Transporte en particular. Chile atraviesa por una oportunidad histórica, quizás paradójicamente, a partir...
Camilo Villa Van Cotthem
Full Text Available Con base en diez estudios de caso realizados en localidades colombianas durante 1997, el autor analiza las alianzas construidas entre gobiernos locales, organizaciones civiles y empresarios. La revisión detallada de las experiencias documentadas permite comprender mejor la lógica, las motivaciones, las reglas y los beneficios de este tipo de procesos. Las alianzas locales aparecen como una opción para generar dinámicas de desarrollo, bajo paradigmas diferentes a aquellos que se centran en el extremo del mercado o en el del Estado, y como una estrategia de largo plazo, de bajo costo y de carácter participativo.
Castillo Moreno, María Esther
Document llistat Consultable des del TDX Títol obtingut de la portada digitalitzada La presente tesis doctoral forma parte de un proyecto de investigación denominado El nuevo significado del trabajo en el subempleo: implicaciones psicosociales, políticas y de genero1, en el que se trata de estudiar, aplicando metodologías y técnicas cuantitativas y cualitativas, el significado del trabajo y la experiencia laboral en distintos entornos iberoamericanos enmarcados a su vez en distintos ...
Patricia Camarena Gallardo; Rubén Edel Navarro; Yadira Navarro Rangel
El artículo presenta resultados preliminares del proyecto "Calidad, evaluación y acreditación de la educación mediada por las tecnologías de la información y la comunicación (TIC)", en particular el análisis realizado con trece expertos en educación a distancia, quienes compartieron las experiencias exitosas de los programas académicos en los cuales habían participado. El contenido del documento resultará de interés para diferentes actores de la educación a distancia, entre ellos gestores, di...
Alejandra AQUINO MORESCHI
Full Text Available Existen muchos estudios sobre las políticas estatales para el control de las fronteras entre norte y sur; sin embargo, hay muy pocos sobre las estrategias concretas, individuales y colectivas que siguen los migrantes para atravesarlas y sobre cómo experimentan este momento clave en su trayectoria migratoria. El artículo siguiente busca abonar a esta tarea; para ello presenta un análisis etnográfico del cruce de la frontera de jóvenes zapotecas y tojolabales originarios de comunidades rurales de Chiapas y Oaxaca con distinta experiencia migratoria.
José Humberto Ospina Rojas
La lectura del libro Experiencias desnudas del Orden. Cuerpos deformes y monstruosos plantea el reto de hallar el vínculo orgánico entre Medicina, Biología e Historiografía durante el siglo XIX. Ese vínculo se encuentra en el concepto de “selección natural interna”. Para comprenderlo a cabalidad es necesario un recorrido precedente, así:En la parte I (La fuga del doble) se esboza la Idea bajo la cual el cuerpo deforme se halla sometido a la forma, es decir, a las mismas leyes que rigen el de...
Andrades C,Patricio; Román F,José Luis; Bartel A,Ricardo; Borel B,Claudio; Hernández N,Rodrigo; Rojas S,René; Lankin B,Jorge; Villalobos A,Rodrigo
Introducción: El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo de la hemorragia incoercible por trauma facial durante los últimos 10 años, para determinar su incidencia y delinear los principios básicos del tratamiento. Material y Método: Estudio retrospectivo de todos los pacientes con hemorragia incoercible por trauma maxilofacial entre 1999 y 2009. Criterios de inclusión fueron hemorragia oro-nasal secundaria a traumatismo maxilofacial, sin otras lesiones asocia...
Medina Luzán, Covadonga
El trabajo es un análisis de la situación que vive la publicidad de unos años a ahora, pero centrándose en el giro que ha dado hacia el consumo de experiencias por parte del consumidor, y la interacción y papel que este ha adquirido respecto a la publicidad. Se hace un recorrido sobre los tipos, dentro del marketing del entrenimiento más representativos, explicando su funcionamiento y beneficios, a través de campañas y acciones de marketing.
Paula Vanessa Sánchez
Bowlby sobre los Vínculos; epistemológicamente se fundamenta en una perspectiva construccionista que indica que los vínculos se construyen en la interacción y en la experiencia cotidiana. En lo metodológico, es una investigación hermenéutica de la que emergen tres categorías: el Vínculo con el Lugar mediado por la Movilidad Territorial; el Vínculo Parental, la Paradoja del Desligamiento y el Arraigo Profundo; y El Vínculo con los Otros¿ Lo Flexible es lo Vinculante.
Luis Fernando Cardona Suárez
Full Text Available En el presente artículo se examinala experiencia del sufrimientohumano indicando la actitud másadecuada para enfrentarlo. Setoma distancia de los intentos dehallar una explicación causal quepermita superarlo o simplementeaminorar sus efectos en el conjuntode la vida. Al mirar esta experienciaa la luz de diversas expresiones artísticas,queremos resaltar el papeldel arte para asumir el dolor comouna puerta que nos abre a lo másinterno de nosotros mismos y, conello, del mundo. Esta puerta es, enefecto, una verdadera medicinamentis.
Chernikoff, Raúl E.; Universidad Nacional de Cuyo - Argentina; Rubio, Luis A.; Universidad Nacional de Cuyo - Argentina; Cáceres, René E.; Universidad Nacional de Cuyo - Argentina; Rodríguez, Osvaldo J.; Universidad Nacional de Cuyo - Argentina
El estudio de las propiedades de los gases es un contenido habitual en los cursos de física y de química de nivel medio y universitario básico. Si bien en la bibliografía se proponen distintas experiencias para ilustrar este tema, la mayoría utiliza mercurio, una sustancia cuyo uso tiende a eliminarse actualmente en los laboratorios, al menos en los de enseñanza. En este trabajo se propone, para estudiar la ley de Boyle, la construcción de un dispositivo sin mercurio fácil d...
En los últimos años, hemos asistido a un desarrollo significativo de los laboratorios remotos. Su integración en el ámbito académico ofrece muchas ventajas desde el punto de vista logístico. No obstante, desde el punto de vistas pedagógico, el impacto de la experimentación remota no es tan evidente. En este trabajo, se presenta una experiencia de utilización de un laboratorio remoto de control, dando las opiniones de los alumnos y así como la del profesor como usuarios de un sistema de experi...
Índice ¿Sostenibilidad o sustentabilidad? 20 años de ambientalismo en Latinoamérica. Y el urbanismo llegó pronto. Los casos reales monitoreados. ¿Consecuencias? ¿Defectos, carencia o debilidades? Las experiencias más recientes Premisas recurrentes Función de sustentabilidad La forma de sustentabilidad Las modalidades necesariasResumenEsta historia de lo sustentable (o sostenible) es de todos modos parte de nuestra reciente historia en América Latina. Desde 1972 y la Conferencia Mundial del Me...
In the field of instrumental methodologies, digestive endoscopy is widely applied diagnostic and therapeutic investigation, involving ethical and medico-legal problems connected with its performance. So, in the light of the present doctor-patient relationship, we therefore wished to reconsider the relevant meaning of preventive information which is indispensable for obtaining the patient's consent to the doctor's action. The aim of this present paper is to provide adequate knowledge, for who ever is about to undergo endoscopic examination, by introducing new informative forms and a new system for their distribution, without negatively affecting the patient's state of anxiety. We have tried to attribute greater responsibility to the person of the doctor requesting the examination, in providing information for the patient, and to underline, in the case of complications, the important conduct of the endoscopic specialist, who must not fail to obtain new informed consent before submitting the patient to any action directed towards treatment of the specific complication. If ignored, these medico-legal aspects can formulate the responsibility of the doctor both in clinical or penal context.
Ilhami Yüksel; (O)zlem Ekiz; Fuat Ekiz; (O)mer Basar; Oeman Yüksel
To the editor:Upper gastrointestinal endoscopy (UGE) is a safe procedure and it is widely used without any complication in general.Complications are due to endoscopic procedure,invasive applications,local anesthetic medication or the sedative drugs like midazolam.Complications of the procedure are hemorrhage,peroration of the stomach or gut,respiratory arrest,reaction to the sedative drugs used like midazolam or pethidine,aspiration pneumonia,damaging of crowned teeth or dental bridgework,infection, cardiac arrest and finally under very unusual circmstances death.Mild complications are sore throat,numb throat,bloated feeling and feeling sleepy.1,2 Oral rash was reported to be a very rare complication (0.3％) of UGE in pediatric population.2 Some scholars reported a facial purpura after endoscopic procedure,previously3-5 Cutaneous complications after UGE may occur,however this condition is usually ignored by physicians.Herein,we present a case of facial purpura in an elderly patient as a mild complication of UGE.
Full Text Available Different sedation or anesthesia protocols are available to enable gastrointestinal endoscopic examinations in children. None is optimal. Sedation is organized according to the medical system, resources and the availability of personnel and medication (sedatives, anesthetics, analgesics. If anesthesiologist’s sedation teams for children are not available, strong evidence supports sedation safety and efficiency when it is performed by specially educated non-anesthesiologists and registered nurses. This review is a brief synthesis of main guidelines and position papers of procedural sedation in children and, when unavailable, in adults, who are eligible for pediatric gastrointestinal endoscopy sedation by non-anesthesiologist. Published data are supplemented by clinical experience and the findings of author’s research on ketamine sedation. Other established sedative combinations are benzodiazepine and opioid or propofol as a sole agent or in combination with analgesics. Special stress is given on a proper choice of the sedation protocol for specific examination or procedure in accordance with institution’s policy. Whole endoscopic team has to be engaged in the implementation of new evidence and continuous education to achieve the highest possible safety and quality standards.
Chen-yi LI; Bing-ling ZHANG; Chun-xiao CHEN; You-ming LI
Objective: To assess the diagnostic efficiency of OMOM capsule endoscopy (CE) in a group of patients with different indications. Methods: Data from 89 consecutive patients (49 males, 40 females) with suspected small bowel disease who under-went OMOM CE (Jinshan Science and Technology Company, Chongqing, China) examination were obtained by retrospective review. The patients' indications of the disease consisted of the following: obscure gastrointestinal bleeding (OGIB), abdominal pain or diarrhea, partial intestinal obstruction, suspected inflammatory bowel disease, tumor of unknown origin, hypoproteinemia, constipation, weight loss, and elevated tumor markers. Results: CE failed in one patient. Visualization of the entire small bowel was achieved in 75.0%. Capsules were naturally excreted by all patients. The detection rate of abnormalities was 70.5% for pa-tients with suspected small bowel disease, and the diagnostic yield for patients with OGIB was higher than that for patients with abdominal pain or diarrhea (85.7% vs 53.3%, P<0.005). Angiodysplasia was the most common small bowel finding. Active bleeding sites were noted in the small intestine in 11 cases. Conclusion: OMOM CE is a useful diagnostic tool for the diagnosis of variably suspected small bowel disease, whose diagnostic efficiency is similar to that of the Pillcam SB (small bowel) CE (Given Imaging, Yoqneam, Israel).
Objective: To study the rule of development of early cancer of gastric cardiac in vivo. Methods: A prospective cohort was held in the high incidence area of cancer of esophagus and stomach in china. One hundred and six persons were examined regularly by endoscopy to observe the change of pro-cancer lesions of gastric cardiac by taking biopsy specimen. All specimens were diagnosed through normal pathological process. Results: The 106 subjects were examined twice in 1998 and 2002. Of 8 normal persons, 3 stayed normal, 4 turned to chronic gastritis, 1 developed early gastric cardiac cancer. Of 61 persons with chronic gastritis, 11 were observed to have gland atrophy, 4 with mild atypical hyperplasia, and 2 with highly atypical hyperplasia. Of 9 subjects showing atrophic chronic gastritis, 5 revealed no change, and 4 became chronic gastritis. Of 22 subjects who revealed mild atypical hyperplasia, 17 resolved, 4 showed no change, and 1 advanced to highly atypical hyperplasia. One person with highly atypical hyperplasia reverted to mild atypical hyperplasia. Of 5 subjects with early gastric cardiac cancer without any treatment, 1 became advanced cancer, 1 still stayed in early cancer stage, 3 turned to atypical hyperplasia. Conclusion: 1. The development of early cancer of gastric cardia would proceed through the stages of chronic gastritis, gland atrophy, and atypical hyperplasia. 2. The early cancer and pre-cancer lesions of gastric cardia is reversible, though possessing malignant possibility.
Broadway, Christian; Gallego, Daniel; Pospori, Andreas; Zubel, Michal; Webb, David J.; Sugden, Kate; Carpintero, Guillermo; Lamela, Horacio
Opto-acoustic imaging is a growing field of research in recent years, providing functional imaging of physiological biomarkers, such as the oxygenation of haemoglobin. Piezo electric transducers are the industry standard detector for ultrasonics, but their limited bandwidth, susceptibility to electromagnetic interference and their inversely proportional sensitivity to size all affect the detector performance. Sensors based on polymer optical fibres (POF) are immune to electromagnetic interference, have lower acoustic impedance and a reduced Young's Modulus compared to silica fibres. Furthermore, POF enables the possibility of a wideband sensor and a size appropriate to endoscopy. Micro-structured POF (mPOF) used in an interferometric detector has been shown to be an order of magnitude more sensitive than silica fibre at 1 MHz and 3 times more sensitive at 10 MHz. We present the first opto-acoustic measurements obtained using a 4.7mm PMMA mPOF Bragg grating with a fibre diameter of 130 μm and present the lateral directivity pattern of a PMMA mPOF FBG ultrasound sensor over a frequency range of 1-50 MHz. We discuss the impact of the pattern with respect to the targeted application and draw conclusions on how to mitigate the problems encountered.
Kwack, Won Gun; Lim, Yun Jeong
Endoscopic investigation has a critical role in the diagnosis and treatment of gastrointestinal (GI) diseases. Since 2001, capsule endoscopy (CE) has been available for small-bowel exploration and is under continuous development. During the past decade, CE has achieved impressive improvements in areas such as miniaturization, resolution, and battery life. As a result, CE is currently a first-line tool for the investigation of the small bowel in obscure gastrointestinal bleeding and is a useful alternative to wired enteroscopy. Nevertheless, CE still has several limitations, such as incomplete examination and limited diagnostic and therapeutic capabilities. To resolve these problems, many groups have suggested several models (e.g., controlled CO2 insufflation system, magnetic navigation system, mobile robotic platform, tagging and biopsy equipment, and targeted drug-delivery system), which are in development. In the near future, new technological advances will improve the capabilities of CE and broaden its spectrum of applications not only for the small bowel but also for the colon, stomach, and esophagus. The purpose of this review is to introduce the current status of CE and to review the ongoing development of solutions to address its limitations.
Stehle, Thomas; Auer, Roland; Gross, Sebastian; Behrens, Alexander; Wulff, Jonas; Aach, Til; Winograd, Ron; Trautwein, Christian; Tischendorf, Jens
The evolution of colon cancer starts with colon polyps. There are two different types of colon polyps, namely hyperplasias and adenomas. Hyperplasias are benign polyps which are known not to evolve into cancer and, therefore, do not need to be removed. By contrast, adenomas have a strong tendency to become malignant. Therefore, they have to be removed immediately via polypectomy. For this reason, a method to differentiate reliably adenomas from hyperplasias during a preventive medical endoscopy of the colon (colonoscopy) is highly desirable. A recent study has shown that it is possible to distinguish both types of polyps visually by means of their vascularization. Adenomas exhibit a large amount of blood vessel capillaries on their surface whereas hyperplasias show only few of them. In this paper, we show the feasibility of computer-based classification of colon polyps using vascularization features. The proposed classification algorithm consists of several steps: For the critical part of vessel segmentation, we implemented and compared two segmentation algorithms. After a skeletonization of the detected blood vessel candidates, we used the results as seed points for the Fast Marching algorithm which is used to segment the whole vessel lumen. Subsequently, features are computed from this segmentation which are then used to classify the polyps. In leave-one-out tests on our polyp database (56 polyps), we achieve a correct classification rate of approximately 90%.
Slawinski, Piotr R; Obstein, Keith L; Valdastri, Pietro
Capsule endoscopy (CE) has transformed from a research venture into a widely used clinical tool and the primary means for diagnosing small bowel pathology. These orally administered capsules traverse passively through the gastrointestinal tract via peristalsis and are used in the esophagus, stomach, small bowel, and colon. The primary focus of CE research in recent years has been enabling active CE manipulation and extension of the technology to therapeutic functionality; thus, widening the scope of the procedure. This review outlines clinical standards of the technology as well as recent advances in CE research. Clinical capsule applications are discussed with respect to each portion of the gastrointestinal tract. Promising research efforts are presented with an emphasis on enabling active capsule locomotion. The presented studies suggest, in particular, that the most viable solution for active capsule manipulation is actuation of a capsule via exterior permanent magnet held by a robot. Developing capsule procedures adhering to current healthcare standards, such as enabling a tool channel or irrigation in a therapeutic device, is a vital phase in the adaptation of CE in the clinical setting.
Woo Sang Hyo
Full Text Available Abstract The aim of this research is to propose a small intestine model for electrically propelled capsule endoscopy. The electrical stimulus can cause contraction of the small intestine and propel the capsule along the lumen. The proposed model considered the drag and friction from the small intestine using a thin walled model and Stokes' drag equation. Further, contraction force from the small intestine was modeled by using regression analysis. From the proposed model, the acceleration and velocity of various exterior shapes of capsule were calculated, and two exterior shapes of capsules were proposed based on the internal volume of the capsules. The proposed capsules were fabricated and animal experiments were conducted. One of the proposed capsules showed an average (SD velocity in forward direction of 2.91 ± 0.99 mm/s and 2.23 ± 0.78 mm/s in the backward direction, which was 5.2 times faster than that obtained in previous research. The proposed model can predict locomotion of the capsule based on various exterior shapes of the capsule.
The ability to manipulate light in subwavelength photonic and plasmonic structures has shown great potentials in revolutionizing how information is generated, transformed and processed. Chemically synthesized nanowires, in particular, offers a unique toolbox not only for highly compact and integrated photonic modules and devices, including coherent and incoherent light sources, waveguides, photodetectors and photovoltaics, but also for new types of nanoscopic bio-probes for spot cargo delivery and in-situ single cell endoscopy and sensing. Such nanowire probes would enable us to carry out intracellular imaging and probing with high spatial resolution, monitor in-vivo biological processes within single living cells and greatly improve our fundamental understanding of cell functions, intracellular physiological processes, and cellular signal pathways. My work is aimed at developing a material and instrumental platform for such single nanowire probe. Successful optical integration of Ag nanowire plasmonic waveguides, which offers deep subwavelength mode confinement, and conventional photonic waveguides was demonstrated on a single nanowire level. The highest plasmonic-photonic coupling efficiency coupling was found at small coupling angles and low input frequencies. The frequency dependent propagation loss was observed in Ag nanowire and was confirmed by quantitative measurement and in agreement with theoretical expectations. Rational integration of dielectric and Ag nanowire waveguide components into hybrid optical-plasmonic routing devices has been demonstrated. This capability is essential for incorporating sub-100nm Ag nanowire waveguides into optical fiber based nanoprobes for single cell endoscopy. The nanoprobe system based on single nanowire waveguides was demonstrated by optically coupling semiconductor or metal nanowire with an optical fiber with tapered tip. This nanoprobe design requires minimal instrumentation which makes it cost efficient and readily
Full Text Available RESUMENLa experiencia fuera del cuerpo (EFC se define como un experiencia mediante la cual el “yo” o centro de conciencia parece ocupar una posición remota respecto a su propio cuerpo. Un total de 648 estudiantes de psicología que incluyó 78% de mujeres y 24% de hombres, completaron un número de escalas para comparar los puntajes de ambos grupos (con EFC N = 132 vs sin EFC N = 516. Los resultados mostraron mayor esquizotipia cognitivo-perceptual, absorción, disociación, propensidad a la fantasía, tendencia a alucinar, imaginería visual en individuos que tienen EFC en comparación con un grupo control. La incidencia de tales experiencias incluye a individuos que han señalado los efectos benéficos de lasEFCs como un modo adaptativo al estrés postraumático.ABSTRACTAbstract. An out-of-body experience or OBE is one in which the “self” or center of awareness seems to the experient to occupy temporarily a position that is spatially remote from his or her body. A total of 648 undergraduate students population included 76% females and 24% males, and who completed a number of scales. Data for experients of OBE were compared with data for those who did not (experients N= 132 vs. non‑experients N= 516. The results showed a higher level of cognitive-perceptual schizotypy, absorption, dissociation, fantasy and hallucination proneness, and visual imagery in OBErs than in non-OBErs. This study suggest that the dissociational model of OBE. Anomalous perceptual experiences and some subjects report beneficial effects from OBEs in an adaptive way.
Meltzer, Andrew C; Pinchbeck, Carrie; Burnett, Sarah; Buhumaid, Rasha; Shah, Payal; Ding, Ru; Fleischer, David E; Gralnek, Ian M
Acute upper gastrointestinal (GI) hemorrhage is a common emergency department (ED) presentation whose severity ranges from benign to life-threatening and the best tool to risk stratify the disease is an upper endoscopy, either by scope or by capsule, a procedure performed almost exclusively by gastroenterologists. Unfortunately, on-call gastroenterology specialists are often unavailable, and emergency physicians (EPs) currently lack an alternative method to endoscopically visualize a suspected acute upper GI hemorrhage. Recent reports have shown that video capsule endoscopy is well tolerated by ED patients and has similar sensitivity and specificity to endoscopy for upper GI hemorrhage. The study objective was to determine if EPs can detect upper GI bleeding on capsule endoscopy after a brief training session. A survey study was designed to demonstrate video examples of capsule endoscopy to EPs and determine if they could detect upper GI bleeding after a brief training session. All videos were generated from a prior ED-based study on patients with suspected acute upper GI hemorrhage. The training session consisted of less than 10 minutes of background information and capsule endoscopy video examples. EPs were recruited at the American College of Emergency Physicians Scientific Assembly in Denver, Colorado, from October 8, 2012, to October 10, 2012. Inclusion criteria included being an ED resident or attending physician and the exclusion criteria included any formal endoscopy training. The authors analyzed the agreement between the EPs and expert adjudicated capsule endoscopy readings for each capsule endoscopy video. For the outcome categories of blood (fresh or coffee grounds type) or no blood detected, the sensitivity and specificity were calculated. A total of 126 EPs were enrolled. Compared to expert gastroenterology-adjudicated interpretation, the sensitivity to detect blood was 0.94 (95% confidence interval [CI] = 0.91 to 0.96) and specificity was 0.87 (95
Arif Ali Kolethekkat
Full Text Available Objectives: To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhino-sinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan.Methods: This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard.Results: Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients (87%. Of these patients, 60/65 (92% showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 (60% had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% (95% CI: 81-97 and 44% (95% CI: 14-79, respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2.Conclusion: Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhino-sinusitis. When clinical suspicion is low (90% of patients when clinical suspicion is high (88% as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce
Full Text Available Background: Capsule endoscopy is a first line examination to evaluate obscure gastrointestinal bleeding. The identification of factors associated with the detection of lesions by capsule endoscopy could improve resource utilization and patient selection. Objectives: To identify factors associated with positive capsule endoscopy findings in patients with obscure gastrointestinal bleeding. Methods: Retrospective, single-center study, including 203 patients (214 capsule endoscopy procedures submitted to capsule endoscopy in the setting of obscure gastrointestinal bleeding. Type of obscure gastrointestinal bleeding, number of units of packed red blood cells transfused, type of positive finding, number of endoscopy studies performed prior to capsule endoscopy, comorbidities, medication and Charlson index were evaluated. Overt bleeding was subdivided into ongoing and previous gastrointestinal bleeding. Only lesions with high hemorrhagic potential (P2 were classified as positive findings. Results: The mean age was 62.2 years and 59.7% of patients were female. Most patients were referred for occult gastrointestinal bleeding (64.5%, while 35.5% were referred for overt gastrointestinal bleeding (63.2% previous-overt gastrointestinal bleeding. The most frequent positive findings included ulcers/erosions (34% and angioectasias (32%. In univariate analysis, the identification of positive findings was significantly higher in those with ongoing-overt bleeding (p < 0.001, advanced age (p = 0.003, increasing number of pre-capsule endoscopies (p < 0.001, increasing transfusion requirements (p < 0.001, moderate/severe renal disease (p = 0.009 and antiplatelet drugs (p = 0.021 and NSAID intake (p = 0.005. In multivariate analysis, positive findings were significantly higher only in those with ongoing-overt bleeding (odds ratio [OR] 18.68, 95% confidence interval [CI] 3.98-85.6, p < 0.001, higher transfusion requirements (OR 1.23, 95% CI 1.1-1.4, p < 0.001 and NSAID
Margarita R. Rodríguez-Gallego
Full Text Available Esta investigación describe la experiencia de Aprendizaje-Servicio vivida y desarrollada por 100 estudiantes-servicio de la Universidad de Sevilla, que participaron voluntariamente durante el curso académico 2013-2014y 104 profesionales de centros educativos. Entre los objetivos, valorar el grado de satisfacción de los participantes en el proyecto ApS y conocer supercepcióncomo futurosdocentes. El diseño de la investigación ha sido mixto, por una parte, exploratorio y no experimental (ex post-factopara conocer las opiniones de los estudiantesy, por otra, el método de codificación abierta de la teoría fundamentada a través del análisis de los diariospara conocer las opiniones de los profesionales.Los resultados obtenidos ponen de manifiesto, tanto para estudiantes como profesionales, que esta experiencia de ApS les ha permitido un mejor desarrollo en el ámbito académico al afianzar los conceptos teóricos, así como en el personalalpoder mejorar sushabilidades sociales y comunicativas,en el profesionalpor la adquisición de cualidades y competencias para el ejercicio profesionaly, por último, en el ámbitosocialaltomar conciencia de las desigualdades.
JUAN CARLOS MONSALVE GÓMEZ
Full Text Available El presente artículo muestra los resultados de la sistematización de la experiencia Vereda La Suiza. Un proyecto educativo con estudiantes en educación básica y media que orienta la Fundación Universitaria Católica del Norte a través del Cibercolegio UCN. Dicho grupo está ubicado en el Corregimiento de Palmitas, Vereda La Suiza, ubicada a la salida del túnel de occidente del municipio de Medellín. El tipo de estudio es sistematización de experiencia, en el cual se hicieron entrevistas, encuestas y revisión documental, en el período de tiempo comprendido entre abril de 2009 y abril de 2010.El artículo evidencia el proceso de investigación desarrollado y los beneficios que este tipo de proyectos representan para las comunidades rurales, alejadas de los sistemas educativos convencionales, permitiendo a los miembros de dichas comunidades, adelantar un estudio en diferentes niveles educativos, sin requerirse del desplazamiento de las personas a otros sitios.
Nélida Lamelas Castellanos
Full Text Available En estas páginas reflexionamos sobre la importancia del trabajo en grupo en la docencia universitaria y comentamos una experiencia de su aplicación en clases interactivas de la materia Política Económica I perteneciente al Grado de Economía en la Universidad de Santiago de Compostela, España. Presentamos una descripción de la metodología desarrollada en esta actividad y las opiniones de la profesora y el alumnado que ponen de manifiesto el alto grado de satisfacción con su utilización.PALABRAS CLAVE: trabajo en grupo; docencia universitaria; experiencia educativaAN EXPERIENCE OF WORK IN GROUP IN HIGHER EDUCATION TEACHING PROCESSABSTRACTIn these pages we meditate about the importance of the work in group in the higher education teaching process and we comment an experience of their application in interactive classes of the matter Economic Political I belonging to the Grade of Economy in the University of Santiago of Compostela, Spain. We present a description of the methodology developed in this activity and the teacher's opinions and the pupil that show the high grade of satisfaction with their use. KEYWORDS: work in group; higher education teaching process; educational experience
Ligni Molano Barona
Full Text Available En este documento se compendia la experiencia que tres profesoras de lengua materna han construido a lo largo de su actividad docente, en lo relacionado con el párrafo. Está estructurado en tres puntos. En el primero, ¿Qué es un párrafo?, se abordan elementos de orden teórico, que, a modo de referentes, sustentan la búsqueda de un concepto propio y eficaz a la hora de emprender la escritura con los estudiantes. Con este fin, se realizó un pequeño estado del arte sobre el estudio del párrafo, en el que se escogieron cinco autores, cuya experiencia en la didáctica textual es bastante amplia, y se indagaron a los pares de la Universidad Icesi. En el segundo, ¿Para qué sirve un párrafo?, se reflexiona acerca de la utilidad y la importancia del párrafo en la escritura de cualquier tipo de texto. En el tercero, ¿Cómo se puede enseñar a escribirlo?, se plantea una metodología para el trabajo del párrafo en el aula.
de Haro, J. José
Full Text Available In this article we show some experiences in educational innovation area performed by teachers with students of ESO and Bachelor at Amor de Dios school in Barcelona (www.amordedios. org. We also discuss the characteristics of blogs, wikis and social networks, as well as their potential usage, all based on the experience carried out with the students. We also present some useful guidelines about selection of the various systems depending on teachers’ needs.Se presentan algunas de las experiencias llevadas a cabo en el ámbito de la innovación educativa con alumnos de ESO y Bachillerato en el centro concertado de educación primaria y secundaria Amor de Dios de Barcelona (www.amordedios.org. Se discuten las características de blogs, wikis y redes sociales, así como sus posibilidades de uso, todo ello en base a las experiencias realizadas con los alumnos. Igualmente se presentan algunas directrices que pueden ayudar para la selección de unos sistemas u otros según las necesidades educativas del profesor.
Meining, A; Atasoy, S; Chung, A; Navab, N; Yang, G Z
Narrow-band imaging (NBI) is a new imaging methodology for improving the detection rate of gastrointestinal lesions. We aimed to evaluate perception of images by NBI and corresponding standard white-light-endoscopy (WLE) using a computer-guided eye-tracking system. A total of 23 NBI images of various lesions with the 23 corresponding WLE images were assessed in random order by 18 subjects with various endoscopy experience. Before evaluation, a teaching set of three NBI and corresponding WLE images was shown to highlight the characteristics of lesions. An eye-tracking system (Tobii X series with integrated 17-inch monitor) was used to record the eye movements of the subjects while they examined respective images. The following parameters were measured: total time spent on image, time until first fixation of lesion, total number of fixations per image and per lesion, and number of fixations until finding the lesion. In total, 828 experiments were conducted. Lesions could not be detected in 6.5 % (NBI) and 4.1 % (WLE) of images ( P = NS). The total number of fixations and total time spent on respective figures as a whole were significantly greater for NBI images compared with WLE images ( P 0.1). This is the first study using eye tracking to evaluate image perception in gastrointestinal endoscopy. Significant differences in the interpretation of NBI and WLE images were observed, which may be relevant for the detection and characterization of lesions during endoscopy. (c) Georg Thieme Verlag KG Stuttgart . New York.
We report the case of a patient with overt obscure gastrointestinal bleeding due to a gastrointestinal stromal tumor diagnosed by CT enterography after two negatives capsule endoscopies. This case shows that capsule endoscopy may overlook significant life threatening lesions and highlights the importance of using other diagnostic modalities after a negative capsule endoscopy, especially in patients with a high index of suspicion for small bowel tumoral pathology or persistent/recurrent bleeding.
J. M. Herrerías Gutiérrez
Full Text Available Introduction: in Spain, there is no indication of the resources that an endoscopy unit should have. As a consequence only the experience of professionals who have been working for years in this field can be used as a guide. However, there are some recent surveys on sedation in Spain that indicate how sedation is use in other units. Objectives: the objectives of the present study were: a to find out the human and material resources available in endoscopy units in Andalusia; b to analyze the number of endoscopies performed in our country; and c to identify factors that can be improved. Material and methods: in order to make an assessment of the conditions and resources of said units in Andalusia, a survey was designed for the staff of gasteroenterology department. Hospitals involved are those specified in this paper. The survey, which included 90 questions, covers all aspects concerning each unit. There are questions on the real conditions of the unit, and on what would be considered as ideal or at least as minimal requirement for each hospital or Health Area. Conclusions: even though some shortcomings were found in some hospitals, a high percentage of them have acceptable equipment. However, due to fast advances in the field of endoscopy, an improvement in the conditions should be provided, especially in aspects concerning anesthesia.Introducción: en España, no se dispone en la actualidad de una guía que sirva para saber con qué recursos debe contar una unidad de endoscopia, por lo que en algunos casos, sólo la experiencia de profesionales que llevan años trabajando en este campo sirve como norma de trabajo. Existen no obstante, algunas encuestas realizadas últimamente en nuestro país sobre la sedación en endoscopia que pueden aportar una idea de cómo se maneja la sedación en otras unidades. Objetivos: a conocer el personal y el material con el que cuentan las unidades de endoscopia encuestadas en Andalucía; b analizar el modo y n
Oluwafunmilayo Funke Adeniyi
Full Text Available Background. Paediatric endoscopy is now standard care in the developed world for the management of gastrointestinal (GI disorders. However, in developing countries endoscopy remains an underutilised tool. Objective. To determine the indications and the spectrum of endoscopic findings in children seen at the Lagos University Teaching Hospital, Nigeria. Methods. The indications for upper GI endoscopy and endoscopic findings in children ≤16 years old, referred for the procedure from June 2013 to June 2016, were documented. The endoscopic yield in these children was also determined. Results. In total 71 children were referred for upper GI endoscopy during the study period. There were 35 boys and 36 girls aged 3 months to 16 years. The indications for upper endoscopy were recurrent abdominal pain in 37 (52.1%, upper GI bleeding in 17 (23.9%, recurrent vomiting in 7 (9.9%, dyspepsia in 5 (7.0, heartburn in 2 (2.8%, dysphagia in 1 (1.4, portal hypertension in 1 (1.4 and ingestion of corrosives in 1 (1.4% of the subjects. Endoscopic findings were as follows: gastritis 19 (26.8%, hiatus hernia in 13 (18.3%, gastric erosions in 12 (16.9%, oesophageal varices 6 (8.4%, duodenitis in 4 (5.6%, gastric ulcer in 3 (4.2%, gastric polyp in 2 (2.8%. The overall endoscopic yield was 60.2%. Conclusion. There is a need to increase the awareness of the role of paediatric endoscopy in the diagnosis and treatment of GI disorders in developing countries. Recurrent abdominal pain still remains a relevant indication for the procedure. The need to develop training programmes for paediatric endoscopy and paediatric gastroenterology in general in developing countries cannot be overemphasised.
Basturk, Ahmet; Artan, Reha; Yılmaz, Aygen
Upper endoscopy can be successfully carried out in children under deep sedation and anaesthesia. However, the best method of upper endoscopy for children who require gastrointestinal intervention has yet to be defined. The aim of this study is to investigate the efficacy and safety of the sedation induced by intravenous midazolam and ketamine during upper endoscopy in children. This study included patients ages 3-18years who had undergone upper endoscopy. All subjects received IV midazolam and ketamine. During the intervention, hypoxia, tachycardia, bradycardia, hypertension, and hypotension were recorded. After the intervention, euphoria, dysphoria, vertigo, visual problems (such as diplopia and nystagmus), and emergencies (such as arrhythmia, convulsion, and hallucination), among other findings, were recorded. Older children who were capable of expressing themselves were questioned to help determine these conditions. The mean age of the study group was was 11.9±3.42years; 54% of the patients were females, and 46% were males. During the upper endoscopy, hypoxia occurred in 9% of patients, mild hypertension in 14%, hypotension in 5%, tachycardia in 23%, bradycardia in 8%, and flushing-urticaria in 2%. After the upper endoscopy, one of the most common complications was sore throat, which occurred in 24% of patients. Vomiting was observed in 14% of patients, dizziness in 24%, diplopia in 27%, euphoria in 3% (5 patients), dysphoria in 4%, and hallucination in 4%. Of the total patients, 4% required oxygen supply with a face mask. The results of our study showed that the use of IV midazolam and ketamine during upper endoscopy in children was safe and effective. Copyright © 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.
Full Text Available Upper gastrointestinal endoscopy is often accompanied by tachycardia which is known to be an important pathogenic factor in the development of myocardial ischemia. The pathogenesis of tachycardia is unknown but the condition is thought to be due to the endocrine response to endoscopy. The purpose of the present study was to investigate the effects of sedation on the endocrine response and cardiorespiratory function. Forty patients scheduled for diagnostic upper gastrointestinal endoscopy were randomized into 2 groups. While the patients in the first group did not receive sedation during upper gastrointestinal endoscopy, the patients in the second group were sedated with intravenous midazolam at the dose of 5 mg for those under 65 years or 2.5 mg for those aged 65 years or more. Midazolam was administered by slow infusion. In both groups, blood pressure, ECG tracing, heart rate, and peripheral oxygen saturation (SpO2 were monitored during endoscopy. In addition, blood samples for the determination of cortisol, glucose and C-reactive protein levels were obtained from patients in both groups prior to and following endoscopy. Heart rate and systolic arterial pressure changes were within normal limits in both groups. Comparison of the two groups regarding the values of these two parameters did not reveal a significant difference, while a statistically significant reduction in SpO2 was found in the sedation group. No significant differences in serum cortisol, glucose or C-reactive protein levels were observed between the sedated and non-sedated group. Sedation with midazolam did not reduce the endocrine response and the tachycardia developing during upper gastrointestinal endoscopy, but increased the reduction in SpO2.
Mishra, Awadhesh Kumar; Nilakantan, Ajith; Sahai, Kavita; Datta, Rakesh; Malik, Ajay
Background Contact Endoscopy is a non invasive tool to visualise alterations in cell architecture in vivo. In this study we investigated the diagnostic accuracy of Contact Endoscopy in detecting malignancy in oral mucosal lesions. Methods 76 patients with oral mucosal lesions requiring biopsy were included. Contact Endoscopy was performed by Otolaryngologist before biopsy and findings recorded. The lesion was then biopsied and sent for histopathological examination by Pathologist who was blinded to Contact Endoscopy findings. Findings of Contact Endoscopy were compared with histopathological findings taking the latter as the gold standard. Two biopsies were reported as ‘inconclusive’ on histopathological examination and hence excluded from the final analysis. Data of the remaining 74 patients is presented here. Results Clinically lesions were diagnosed as ulcero-proliferative lesions in 34 patients, Leukoplakia in 19, Erythroplakia in 9, Lichen planus in 5 and Submucous fibrosis in 7 patients. Histopathological examination revealed presence of malignancy in 97.06% of ulcero-proliferative mucosal lesions, 10.53% of leukoplakia and 33.33% of erythroplakia while corresponding figures on Contact Endoscopy were 94.12%, 5.26% and 11.11% respectively. No malignancy was detected in lichen planus and submucous fibrosis by either technique. When compared with histopathological examination, CE showed sensitivity of 84.21%, specificity of 94.44% and accuracy of 89.19%. No adverse effects on the patients were seen due to the procedure or stain. Conclusion Contact Endoscopy may be useful in determining cellular structure in vivo without biopsy to detect oral malignancy early. Further studies are suggested. PMID:25378780
Linke, Georg R; Zerz, Andreas; Kapitza, Florian; Warschkow, Rene; Lange, Jochen; Meyenberger, Christa M; Binek, Janek
To date, transgastric access in humans for natural orifice transluminal endoscopic surgery (NOTES) has been poorly evaluated. To compare endoscopic visualization of the transgastric access point with the laparoscopically defined ideal entrance to the peritoneal cavity. Prospective pilot study in humans. Single tertiary-care center. This study involved 31 patients referred for laparoscopic cholecystectomy. Access points were marked by endoscopy alone, endoscopy combined with diaphanoscopy, and endoscopy after pneumoperitoneum. Points were correlated with a laparoscopically visualized, previously defined ideal access area. To choose the appropriate access point within the laparoscopically defined ideal access area to the peritoneal cavity away from major vessels and adjacent organs, by using endoscopy and to establish landmarks for the endoscopist, look for a learning curve, and identify potential problems. The percentage of access points within the laparoscopically defined ideal area was 35.5% with endoscopy alone, 13.8% using the diaphanoscopy method, and 45.2% after transcutaneous pneumoperitoneum. A safe access point (> or = 3 cm from major gastric vessels) could be achieved with the 3 techniques in 83.9%, 65.5%, and 87.1% of patients, respectively. A positive learning curve for endoscopic localization was identified before (P = .008) and after (P = .014) pneumoperitoneum. Virtual complications were greater in obese patients. This was a small pilot study with hypothetical complications and problems, because actual transgastric access was not performed. The criteria for an ideal access area were very strict. Endoscopy, especially with the use of pneumoperitoneum, can reliably locate a safe transgastric entrance point. However, the endoscopically chosen site correlates poorly with the ideal laparoscopically determined site for transgastric access. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Zvi Fireman; D Paz; Y Kopelman
AIM: To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa.METHODS: Ninety-five patients underwent capsule endoscopy (CE) by easily swallowing the capsule. They were divided into three study groups according to the preparation used: group A (n = 26) by polyethylene glycol (PEG) liter or with sodium phosphate (SP) 12 h prior to the CE study; group B (n = 29) by erythromycin 1 h prior to the CE study; and group C (n = 40) without any preparation. Visualization ranged from good to satisfactory to poor.RESULTS: The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer (163.7 min, P = 0.05). The transit times of the three sub-groups were not affected by gender or pathology.The grade of cleaning of the entire study group was 3.27±1.1. The erythromycin group presented significantly the worst quality of images (P = 0.05) compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One (1.05%) case had no natural excretion.CONCLUSION: Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.
Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas
Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no
Yasuo Kakugawa; Kazuhide Higuchi; Shinji Tanaka; Hideki Ishikawa; Hisao Tajiri; Yutaka Saito; Shoichi Saito; Kenji Watanabe; Naoki Ohmiya; Mitsuyuki Murano; Shiro Oka; Tetsuo Arakawa; Hidemi Goto
AIM:To evaluate the effectiveness of our proposed bowel preparation method for colon capsule endoscopy.METHODS:A pilot,multicenter,randomized controlled trial compared our proposed "reduced volume method" (group A) with the "conventional volume method" (group B) preparation regimens.Group A did not drink polyethylene glycol electrolyte lavage solution (PEGELS) the day before the capsule procedure,while group B drank 2 L.During the procedure day,groups A and B drank 2 L and 1 L of PEG-ELS,respectively,and swallowed the colon capsule (PillCam COLON(R) capsule).Two hours later the first booster of 100 g magnesium citrate mixed with 900 mL water was administered to both groups,and the second booster was administered six hours post capsule ingestion as long as the capsule had not been excreted by that time.Capsule videos were reviewed for grading of cleansing level.RESULTS:Sixty-four subjects were enrolled,with results from 60 analyzed.Groups A and B included 31 and 29 subjects,respectively.Twenty-nine (94％) subjects in group A and 25 (86％) subjects in group B had adequate bowel preparation (ns).Twenty-two (71％) of the 31 subjects in group A excreted the capsule within its battery life compared to 16 (55％) of the 29 subjects in group B (ns).Of the remaining 22 subjects whose capsules were not excreted within the battery life,all of the capsules reached the left side colon before they stopped functioning.A single adverse event was reported in one subject who had mild symptoms of nausea and vomiting one hour after starting to drink PEG-ELS,due to ingesting the PEG-ELS faster than recommended.CONCLUSION:Our proposed reduced volume bowel preparation method for colon capsule without PEG-ELS during the days before the procedure was as effective as the conventional volume method.
Orel, Rok; Brecelj, Jernej; Dias, Jorge Amil; Romano, Claudio; Barros, Fernanda; Thomson, Mike; Vandenplas, Yvan
AIM: To present evidence and formulate recommendations for sedation in pediatric gastrointestinal (GI) endoscopy by non-anesthesiologists. METHODS: The databases MEDLINE, Cochrane and EMBASE were searched for the following keywords “endoscopy, GI”, “endoscopy, digestive system” AND “sedation”, “conscious sedation”, “moderate sedation”, “deep sedation” and “hypnotics and sedatives” for publications in English restricted to the pediatric age. We searched additional information published between January 2011 and January 2014. Searches for (upper) GI endoscopy sedation in pediatrics and sedation guidelines by non-anesthesiologists for the adult population were performed. RESULTS: From the available studies three sedation protocols are highlighted. Propofol, which seems to offer the best balance between efficacy and safety is rarely used by non-anesthesiologists mainly because of legal restrictions. Ketamine and a combination of a benzodiazepine and an opioid are more frequently used. Data regarding other sedatives, anesthetics and adjuvant medications used for pediatric GI endoscopy are also presented. CONCLUSION: General anesthesia by a multidisciplinary team led by an anesthesiologist is preferred. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an alternative, but should be in line with national legislation and institutional regulations. PMID:26240691
Iwasaki, Hiroyasu; Shimura, Takaya; Yamada, Tomonori; Aoki, Miho; Nomura, Satoshi; Kusakabe, Atsunori; Kanie, Hiroshi; Ban, Tesshin; Hayashi, Katsumi; Joh, Takashi; Orito, Etsuro
Patients with active upper gastrointestinal bleeding (UGIB) require urgent endoscopy, but appropriate criteria for urgent endoscopy in these patients have not yet been established. The goal of this study is to establish a simple system for the selection of UGIB patients who may benefit from urgent endoscopy. Of the 335 patients who required emergency hospitalization for UGIB from May 2010 to March 2012 at Nagoya Daini Red Cross Hospital, 166 patients who underwent placement of a nasogastric tube (NGT) were retrospectively identified. Active bleeding on the endoscopic image was used as an endpoint that reflected the need for urgent endoscopy. The ratio of the heart rate to the systolic blood pressure (HR/SBP ratio) and aspiration of fresh or dark red fluid from the NGT [NGT(+)] were significant predictors of active bleeding in the univariate analysis [HR/SBP ratio, P=0.016; NGT(+), Pbleeding in the multivariate analysis. Moreover, receiver operating characteristic analysis revealed a setting with HR/SBP ratio>1.4 or NGT(+) to be optimal criteria to predict active bleeding. These criteria were associated with a sensitivity of 64.9% (24/37) and a specificity of 76.7% (99/129) for the prediction of active bleeding; consequently, they are superior to the sensitivity and specificity of previously proposed criteria. A novel and simple criteria system using NGT(+) and HR/SBP is a good predictor of the need for urgent endoscopy in patients with nonvariceal UGIB.
Sun, Z. [Dept. of Imaging and Applied Physics, Curtin Univ. of Tech., Perth, WA (Australia); Allen, Y.; Fitzsimmons, B.; Hartely, D. [Cook R and D, WA (Australia); Lawrence-Brown, M. [Dept. of Public Health, Curtin Univ. of Tech., Perth, WA (Australia)
We aim in this study to investigate the potential value of CT virtual intravascular endoscopy in patients diagnosed with abdominal aortic aneurysms undergoing fenestrated stent grafts. Both pre-and post-fenestration (within 3 months of implantation) multislice CT data were collected in eight patients and used for generation of virtual endoscopy images in our preliminary study. Variable fenestrations were deployed in 25 aortic branches with scallop fenestration implanted in six aortic ostia, large fenestration in four aortic ostia and small fenestration in 15 renal ostia, respectively. Measurements of the aortic ostia diameters both pre- and post-fenestration were successfully performed with virtual intravascular endoscopy visualization, and endovascular stents as well as their relationship to the aortic ostia were clearly demonstrated. Our results showed that there was no significant change of diameter of the aortic ostia following fenestrated stem grafts. Endovascular stents were clearly visualized on virtual endoscopy images, and no apparent deformity or malrotation was observed in this small group. Our preliminary study provides new insights into anatomic configuration/dimension of aortic ostia and endovascular stents, and virtual intravascular endoscopy could be a valuable technique to follow-up patients treated with fenestrated stent grafts. (orig.)
Full Text Available Pediatric endoscopy has evolved into an indispensable tool in the diagnosis and management of gastrointestinal diseases in children. However, there is limited literature focusing on quality improvement initiatives in pediatric endoscopy. The primary goal of this project was to reduce the no-show rate in the pediatric endoscopy unit. Also, we aimed to improve patient and family satisfaction with the procedure by identifying opportunities for improvement. A checklist was designed based on the potential causes of no-show. The endoscopy nurse coordinator reviewed the checklist when scheduling the procedure to identify patients at high risk for non-compliance. Once a risk factor was identified, appropriate actions were taken. She also made a pre-procedure phone call as a reminder and to address any of these risks for non-compliance if present. A patient satisfaction survey was used to identify potential areas for improvement. The no-show rate decreased from an average of 7% in the pre-intervention phase to 2% in the post-intervention phase (p = 0.009. 91% of the patients/family recorded an overall satisfaction of 4 or 5 on a scale of 1–5 5 being best. Quality improvement strategies decreased the no-show rate in the pediatric endoscopy unit. A patient satisfaction survey helped in identifying areas for improvement.
Jeong, Woo Seong; Song, Hyun Joo; Na, Soo Young; Boo, Sun Jin; Kim, Heung Up; Kim, Jinseok; Choi, Guk Myung
Ischemic enteritis is caused by either the interruption or significant reduction of arterial inflow to the small intestine. Risk factors are old age, diabetes mellitus and cardiovascular disease. It is very rare in young patients. We experienced a 21-year-old man with recurrent acute ischemic enteritis who was diagnosed with capsule endoscopy. He had previously taken medications for pulmonary hypertension and obstruction of both carotid arteries, and about 20 months earlier, he had been admitted due to hematochezia. Two sessions of angiography did not reveal the cause of hematochezia. At that time, capsule endoscopy showed mucosal edema and erythema in the terminal ileum, suggesting healed ischemic enteritis. The patient was admitted again due to hematochezia. Abdominal computed tomography showed focal celiac trunk stenosis and diffuse wall thickening of the small intestine, suggesting ischemic enteritis. Capsule endoscopy showed multiple active ulcers and severe hemorrhage with exudate, extending from the proximal jejunum to the terminal ileum. Using capsule endoscopy, the patient was diagnosed with acute extensive ischemic enteritis. Because endoscopic images of ischemic enteritis have rarely been reported, we report a case of a 21-year-old man who was diagnosed acute extensive ischemic enteritis with capsule endoscopy.
Abreu, João Paulo Saraiva
Full Text Available Introduction: Computed tomography (TC generated tridimensional (3D reconstructions allow the observation of cavities and anatomic structures of our body with detail. In our specialty there have been attempts to carry out virtual endoscopies and laryngoscopies. However, such application has been practically abandoned due to its complexity and need for computers with high power of graphic processing. Objective: To demonstrate the production of 3D reconstructions from CTs of patients in personal computers, with a free specific program and compare them to the surgery actual endoscopic images. Method: Prospective study in which the CTs proper files of 10 patients were reconstructed with the program Intage Realia, version 2009, 0, 0, 702 (KGT Inc., Japan. The reconstructions were carried out before the surgeries and a virtual endoscopy was made to assess the recess and frontal sinus region. After this study, the surgery was digitally performed and stored. The actual endoscopic images of the recess and frontal sinus region were compared to the virtual images. Results: The 3D reconstruction and virtual endoscopy were made in 10 patients submitted to the surgery. The virtual images had a large resemblance with the actual surgical images. Conclusion: With relatively simple tools and personal computer, we demonstrated the possibility to generate 3D reconstructions and virtual endoscopies. The preoperative knowledge of the frontal sinus natural draining path location may generate benefits during the performance of surgeries. However, more studies must be developed for the evaluation of the real roles of such 3D reconstructions and virtual endoscopies.
Fakheri, H T; Kiasari, A Z; Taghvaii, T; Hosseini, V; Mohammadpour, R A; Nasrollah, A; Kabirzadeh, A; Shahmohammadi, S
The aim of this study was to evaluate the prevalence of hypoxia related to midazolam sedation during upper gastrointestinal endoscopy. This single blind randomized placebo control clinical trial, carried out on 180 patients who referred to endoscopy clinic at Imam Khomeini Hospital for selective upper gastrointestinal endoscopy from April to July in 2008. Informed consents obtained from all participants. Patients under 18-years-old, obese, previous history of asthma, COPD and cigarette smoking were excluded. Arterial hemoglobin saturation controlled by finger probe pulse oximetry. After pharyngeal lidocaine spray, midazolam was administered intravenously in case group and patients in controlled group received placebo. Demographic characteristics and other variables were recorded in a questionnaire and data analyzed using SPSS software. Gastrointestinal disturbances and epigastric pain were major indications of endoscopies. The most common endoscopic diagnoses were deudonitis, esophagitis or gastroesophagial reflux. No patients had any serious episode of hypoxia and the incidence of mild hypoxia was not significant in both studied group (p = 0.823). There was no significant difference in arterial oxygen saturation recorded by the three endoscopists (p = 0.734). Our data showed that optimal dose of sedation had no hypoxia. So that, we recommend sedative endoscopy in patients without risk factors for hypoxia.
Christoforos Krystallis; Gail S Masterton; Peter C Hayes; John N Plevris
The management of complications in liver disease is often complex and challenging. Endoscopy has undergone a period of rapid expansion with numerous novel and specialized endoscopic modalities that are of increasing value in the investigation and management of the patient with liver disease. In this review, relevant literature search and expert opinions have been used to provide a brief overview and update of the current endoscopic management of patients with liver disease and portal hypertension. The main areas covered are safety of endoscopy in patients with liver disease, the use of standard endoscopy for the treatment of varices and the role of new endoscopic modalities such as endoscopic ultrasound, esophageal capsule, argon plasma coagulation, spyglass and endomicroscopy in the investigation and treatment of liver-related gastrointestinal and biliary pathology. It is clear that the role of the endoscopy in liver disease is well beyond that of just treating varices. As the technology in endoscopy expands, so does the role of the endoscopist in liver disease.
Hoo-Yeon Lee; Sun Mi Lim; Mi Ah Han; Jae Kwan Jun; Kui Son Choi; Myung-Il Hahm; Eun-Cheol Park
AIM: To measure the perceived satisfaction with gastric cancer screening as part of the National Cancer Screening Program (NCSP) in South Korea. METHODS: Data were derived from the participants in a satisfaction survey of the Quality Evaluation of National Cancer Screening in 2009. This is a populationbased nationwide telephone survey of participants who were screened by the NCSP between May and October 2009. This study included 4412 participants who provided full sets of data and who had upper endoscopies for the purpose of gastric cancer screening. RESULTS: The negative appraisal percentages for each of the seven questions were as follows: explanation in preparation for the upper endoscopy, 12.3%; explanation about the process and procedure of the upper endoscopy, 13.8%; explanation about any pain or discomfort related to the upper endoscopy, 27.5%; level of pain during the procedure, 30.3%; physical environment, 16.2%; manner of the staff, 11.2%, and privacy protection, 8.8%. CONCLUSION: The critical issues identified by the Pareto analysis include the adequacy of the explanation about any pain or discomfort associated with the upper endoscopy and the level of pain experienced during the procedure.
Joel R Judah; Peter V Draganov
Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts.For many years,technological challenges have made performing these procedures difficult.The "mother-baby" system and other various miniscopes have been developed,but routine use has been hampered due to complex setup,scope fragility and the time consuming,technically demanding nature of the procedure.Recently,the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options.The clinical utility of intraductal endoscopy is broad.It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue.Therapeutic interventions,such as electrohydraulic lithotripsy (EHL),laser lithotripsy,photodynamic therapy,and argon plasma coagulation (APC),may also be performed as part of intraductal endoscopy.Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP),and as technology progresses,it is likely that its utilization will only increase.In this review of intraductal endoscopy,we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.
In the last decades many advances have been achievedin endoscopy, in the diagnosis and therapy ofcholangiocarcinoma,however blood test, magneticresonance imaging, computed tomography scan mayfail to detect neoplastic disease at early stage, thus thediagnosis of cholangiocarcinoma is achieved usuallyat unresectable stage. In the last decades the roleof endoscopy has moved from a diagnostic role toan invaluable therapeutic tool for patients affectedby malignant bile duct obstruction. One of the majorissues for cholangiocarcinoma is bile ducts occlusion,leading to jaundice, cholangitis and hepatic failure.Currently, endoscopy has a key role in the work upof cholangiocarcinoma, both in patients amenable tosurgical intervention as well as in those unfit for surgeryor not amenable to immediate surgical curative resectionowing to locally advanced or advanced disease, withpalliative intention. Endoscopy allows successful biliarydrainage and stenting in more than 90% of patientswith malignant bile duct obstruction, and allows rapidreduction of jaundice decreasing the risk of biliary sepsis.When biliary drainage and stenting cannot be achievedwith endoscopy alone, endoscopic ultrasound-guidedbiliary drainage represents an effective alternativemethod affording successful biliary drainage in morethan 80% of cases. The purpose of this review is tofocus on the currently available endoscopic managementoptions in patients with cholangiocarcinoma.
Mery Luz Valderrama Sanabria
Full Text Available Introducción: El objetivo de la investigación fue describir la experiencia de profesionales de enfermería en cargos administrativos en salud para fomentar el liderazgo en el futuro profesional de enfermería. Materiales y Métodos: Investigación cualitativa tipo descriptivo, con diseño narrativo de tópicos puesto que se enfoca en una temática que hace referencia al liderazgo en enfermería. Resultados: Se obtuvieron tres categorías: Experiencias exitosas, de la cual surgieron dos subcategorías: óptimo uso de los recursos y cuidado desde cargos directivos. Las otras categorías se denominaron; liderazgo en enfermería y profesional del futuro. Discusión: Los resultados fueron analizados a la luz de la literatura encontrando semejanzas en cuanto a que el mercado laboral solicita del enfermero la aplicación del liderazgo y se debe redimensionar la formación del futuro profesional y nuevos escenarios de práctica para que responda a las necesidades de un país. Conclusiones: Las dificultades se presentan para ejercer liderazgo al inicio de la vida laboral son el temor, desconocimiento de los derechos como empleado y no saber cuánto vale el trabajo de enfermería. Posteriormente se van presentando por malos entendidos, relaciones interpersonales poco adecuadas, ausencia de colegaje y falta de posicionamiento y reconocimiento de la profesión. Ser líder es un proceso casi inherente a enfermería ya sea desde el ámbito clínico, comunitario o a través del ejercicio de cargos administrativos y se debe fomentar y potenciar en el estudiante.Palabras clave: Liderazgo, Enfermeros, Educación Continua, Satisfacción en el Trabajo. (Fuente: DeCS BIREME.Cómo citar este artículo: Valderrama ML. Experiencias exitosas de liderazgo en enfermería. Rev Cuid. 2014; 5(2: 765-73. http://dx.doi.org/10.15649/cuidarte.v5i2.89
Leonardo Ortegón-Cortázar; Alfredo Gómez Rodríguez
El rápido desarrollo de mercados con productos competitivos de difícil diferenciación y consumidores mejor informados que demandan experiencias memorables, justifican estudiar los elementos sensoriales que pueden potenciar e influir positivamente sobre dichas experiencias. El objetivo de este artículo es analizar el estado del arte respecto a la gestión y uso del marketing sensorial sobre la experiencia del consumidor. El diseño de investigación es no experimental documental, con un tipo de e...
Antonio L. Manzanero; Grandes, Irene; Jódar, Jennifer
En el presente estudio se analizó el papel de la experiencia y la edad sobre la capacidad para describir y reconocer personas. Dos grupos de sujetos con diferente experiencia en tareas de descripción y reconocimiento (civiles y policías) y con dos niveles de edad (jóvenes y adultos) describieron y trataron de reconocer a un hombre y una mujer en sendas ruedas fotográficas de reconocimiento. Los resultados mostraron que los jóvenes policías, con escasa experiencia profesional, y los civiles jó...
Mendoza Lascano, Mireya; Palacio López, Carolina
El mercadeo experiencial se basa en tres componentes fundamentales: la organización, la experiencia del usuario y las personas -- La organización es la encargada de definir el contexto en el que una experiencia se llevará a cabo -- Las personas se ven como seres racionales y emocionales y el mercadeo da prioridad a lo emocional y, por lo tanto, busca maneras de medir las emociones -- Por último, la experiencia del usuario, que constituye un suceso construido de manera individual por cada pers...
Mauricio Mancilla Muñoz
Se busca mostrar la mutua correspondencia entre experiencia e historicidad en la obra de H.-G. Gadamer. La experiencia es entendida como el movimiento fundamental de la existencia histórica, la cual articula las diversas esferas de la acción humana. La experiencia hermenéutica pone de manifiesto que el comprender no puede fundarse en un procedimiento metódico, sino en la forma del existir situado en el mundo. El acto hermenéutico es entendido como un continuo proceso de apropiación que se rea...
Mancilla Muñoz, Mauricio
Se busca mostrar la mutua correspondencia entre experiencia e historicidad en la obra de Hans-Georg Gadamer. La experiencia es entendida como el movimiento fundamental de la existencia histórica, la cual articula las diversas esferas de la acción humana. La experiencia hermenéutica pone de manifiesto que el comprender no puede fundarse en un procedimiento metódico, sino en la forma del existir situado en el mundo. El acto hermenéutico es entendido como un continuo proceso de apropiación, que ...
Heredia Avalos, S.
Full Text Available En este trabajo se describen varias experiencias sencillas relacionadas con las reacciones ácido-base. Todas ellas pueden realizarse con utensilios de cocina y usando sustancias baratas que pueden encontrarse fácilmente en un supermercado, una farmacia o en casa. En concreto, se describe la forma de obtener algunos indicadores de pH a partir de extractos vegetales o de medicamentos. Además, se proponen varias experiencias en las que se hace uso de estos indicadores con el fin de estudiar las reacciones ácido-base. Todas estas experiencias están enfocadas a alumnos de enseñanza secundaria.
Perucca P.,Ernesto; Muñoz M,Pablo; Liendo P,Federico; Ricci A,Paolo; Pérez C,Cristian; Domínguez C,Claudio; Rubio L,Alejandro; Martin P,Rodrigo; Alvarez C,Daniela; Antolini T.,Mónica; Aceituno B,Romina
Presentamos nuestra experiencia de 14 embarazos en portadoras de púrpura trombocitopénico idiopático (PTI) en un lapso de 11 años, 8 de ellos activos (trombocitopénicos) y 6 inactivos (plaquetas normales). La incidencia de la enfermedad en nuestro Servicio fue de 1 en 5.554 embarazos. La edad materna fluctuó entre 18 y 38 años con una mediana de 28 años; 5 eran nulíparas (36%) y 9 multíparas (64%). Seis de las pacientes presentaron síntomas clínicos como epistaxis, gingivorragia, equimosis y ...
Patricia Camarena Gallardo
Full Text Available El artículo presenta resultados preliminares del proyecto "Calidad, evaluación y acreditación de la educación mediada por las tecnologías de la información y la comunicación (TIC", en particular el análisis realizado con trece expertos en educación a distancia, quienes compartieron las experiencias exitosas de los programas académicos en los cuales habían participado. El contenido del documento resultará de interés para diferentes actores de la educación a distancia, entre ellos gestores, diseñadores y profesores, en virtud de que proporciona conocimiento relevante sobre dicha modalidad educativa.
Jiménez Quintero, José Antonio
Full Text Available Este trabajo analiza la relevancia que presenta, en el ámbito internacional, la Responsabilidad Social en las instituciones de educación superior (RSU. Se ha expuesto, después de introducir y delimitar el tema objeto de estudio, un conjunto de experiencias en el contexto referido. Entre ellas, se ha prestado especial atención al Assessment Instrument for Sustainability in Higher Education (Proyecto AISHE, aunque la totalidad de iniciativas presentadas contribuyen a reforzar la incorporación de la Responsabilidad Social en los sistemas de gestión y en las políticas de las universidades y el resto de instituciones de educación superior, poniendo de manifiesto el papel, fundamental y necesario, que desempeña en el avance de las sociedades.
El uso de la tecnología de la información y las comunicaciones permite explorar nuevas alternativas para la mejora del proceso de enseñanza-aprendizaje. En esta comunicación se exponen los resultados obtenidos en relación con la docencia de la materia de Teoría de Autómatas durante el segundo año de la experiencia piloto de implantación de la docencia inversa en el Grado de Informática de la Universidad Politécnica de Valencia. Los buenos resultados obtenidos por el equipo en el primer año su...
Jorge Díaz Tejeda
Full Text Available Este artículo propone Premisas Conceptuales, Premisas Metodológicas y el desarrollo de Aspectos Estratégicos para la implementación de soluciones a la Movilidad Urbana. Se inspira en las ideas, experiencias e investigaciones de diversas personas quienes abordan desde lógicas puntuales aspectos temáticos específicos en el marco de la Planificación Urbana en general y de las aplicaciones en Transporte en particular. Chile atraviesa por una oportunidad histórica, quizás paradójicamente, a partir de un evento de catástrofe ocurrido en Febrero del 2010; esta oportunidad es la de re-plantear el proceso de Planificación Urbana bajo los alcances del Desarrollo Sustentable.
A partir del año 2000 comencé a trabajar en cursos de Extensión Universitaria, que tenían como objetivo analizar el arte del siglo XX. Incursionar en la historia del arte fue un gran desafío personal, que enriqueció mi formación teórica y mi experiencia docente. En todos estos años, entre los que dicté, alternativamente, los cursos de Extensión “Siglo XIX: Simbolismo y Art Nouveau”, “Siglo XX: ¿Cómo entender el Arte Moderno?” (I y II) y “Pintura”; recibí muchas gratificaciones como profesora ...
Full Text Available La investigación está fundamentada por un estudio experimental, enfocado en la evaluación del comportamiento de los usuarios finales interactuando con tiempos de respuestas en aplicaciones reales. Se tomará como base el aporte de los autores Doherty y Thadani, investigadores de IBM relacionado con los tiempos de respuestas, y las investigaciones de Jacob Nielsen. Se llevarán a cabo un test con usuarios finales, y se expondrán optimizaciones a través de del uso de herramientas que contribuirán a mejorar los tiempos de respuestas de las aplicaciones web. Todo esto engloba una primera instancia de un proyecto que se está llevando a cabo en la empresa GeneXus Consulting, pretendiéndose lograr un punto de encuentro entre el rendimiento de las aplicaciones y la experiencia de usuario.
Paula Correa Camus
Full Text Available La incorporación de la mediación familiar como un trámite previo y obligatorio al proceso judicial ha generado una amplia discusión en la doctrina y en los operadores del sistema. Uno de los debates más interesantes es aquel que pretende determinar los efectos de la obligatoriedad tanto en los procesos mismos de mediación como en sus resultados. El objetivo de este trabajo es examinar las ventajas y desventajas que traen aparejadas las políticas públicas que incluyen la participación obligatoria en mediación y, en ese contexto, analizar la experiencia chilena en mediación familiar.
Elber Berdugo Cotera
Full Text Available El presente articulo tiene como objetivo mostrar la importancia de la Historia Empresarial y la constitución de una línea de investigación para el entendimiento de la historia del país y la comprensión de las principales características de nuestros empresarios tanto en el ámbito regional como en el nacional. Se trata igualmente, de dar cuenta de los aspectos teóricos y metodológicos utilizados en la investigación sobre el estudio de caso de Servientrega y sus gestores, lo mismo que de los principales hallazgos encontrados en ella. Por último, señalar cómo ésta clase de experiencias pueden resultar enriquecedoras para aquellas personas que ejercen una función educativa empresarial o pretenden asumir como proyecto personal y familiar de vida ser empresarios.
Johnny Alvarez Jaramillo
Full Text Available RESUMEN Las necesidades de financiamiento de corto plazo, ha determinado el aguzamiento de la imaginación para garantizar los recursos. Generalmente, las prácticas financieras en Colombia se extienden sin ningún control institucional; hasta que desafortunadamente, las prácticas desleales o fraudulentas, llevan al estado a intervenir y reglamentar. Las llamadas MESAS DE DINERO, se han generalizado en nuestro medio en la medida en que proveen recursos financieros de corto plazo, difíciles de conseguir por los canales tradicionales. Los recientes escándalos del sector bursátil y anteriormente, la crisis bancaria, desaceleraron el crecimiento del mercado financiero extrainstitucional, pero no lo han acabado del todo.El presente artículo, pretende informar brevemente sobre las experiencias de las llamadas MESAS DE DINERO, su práctica y desarrollo.
Revisión de la experiencia de la Unión de Ejidos de Producción Agropecuaria “General Lázaro Cárdenas” de la ex-laguna de Magdalena en el estado de Jalisco, constituida en 1976, como una muestra objetiva de la capacidad de la gente de campo para apropiarse de formas de producción y comercialización con creciente grado de autonomía. Se muestra el proceso seguido para constituir la organización, los programas económicos que han operado dentro de la Unión y se hace una reflexión sobre el ejercici...
Marita Sánchez Moreno
Full Text Available La Universidad española se encuentra en un momento crítico y decisivo. Los retos y desafíos que afrontará en estos próximos años relacionados con la Convergencia Europea van a suponer necesariamente cambios conceptuales y estructurales importantes. Uno de los pilares fundamentales que sustenta este proceso de cambio radica en tomar conciencia de la importancia que supone prestar atención a los procesos de formación de los docentes universitarios, una actividad que tradicionalmente se ha relegado en nuestra universidad. Este artículo argumenta la conveniencia de incorporar procesos de asesoramiento en el contexto universitario de manera sistemática e institucionalizada, como herramienta para la formación de los docentes en este modelo nuevo de universidad, y en consecuencia, como ayuda hacia la mejora y al incremento de la calidad docente. Partimos de la idea de aprovechamiento de recursos humanos existentes en la propia Universidad. Por eso, planteamos la pertinencia de recuperar la experiencia de profesores veteranos en la institución para la puesta en marcha de estos procesos de asesoramiento universitarios, ya que estos profesores conocen bien la cultura institucional y dominan el contenido curricular del área disciplinar. El artículo analiza la figura de estos profesores denominados mentores desde la comprensión de rol como tal, las características que les son atribuidas, la formación requerida para el desempeño de las funciones de asesoramiento, las actividades encomendadas y las dificultades detectadas en el ejercicio del rol. Este análisis queda ilustrado por la experiencia de asesoramiento desarrollada en la Universidad de Sevilla.
Barroso Fernández, Óscar
Full Text Available The aim of this paper is to reconstruct the Zubirian approach to the moral kind of knowledge. It is, therefore, necessary to examine Zubiri’s writings on moral anthropology from the 1950s, starting from the most complete one, namely Sentient intelligence. If there is the possibility of contemplating a moral knowledge, we should discover its reference system and determine how it is built upon the contents given in the primordial impression of reality, mediated by the logos and its particular form of knowledge, with all the outlines, experiences and truths. On this basis, we prove that is impossible to found morality in a universal and absolute sense. In any case, the possibility of a universal sphere should not be conceived as something a priori, but rather as a regulative ideal of moral experience, that is, something that reason always tends towards, but never reaches.En este trabajo se pretende reconstruir la propuesta zubiriana de un saber de tipo moral. Este objetivo exige mirar los textos de antropología moral escritos por Zubiri en los años cincuenta desde su obra más acabada: Inteligencia sentiente. Si efectivamente se puede hablar de un saber moral, habrá que descubrir cuál es su sistema de referencia, constituido por determinados contenidos dados en impresión primordial de realidad y mediados por el logos, y su forma de conocimiento, con sus esbozos, experiencias y verdades. A partir de aquí, el autor muestra que no es posible, desde la filosofía de Zubiri, proponer una fundamentación de la moral en sentido universal y absoluto. En todo caso, la posibilidad de un ámbito universal de moralidad no puede ser entendida como algo dado a priori, sino más bien como un ideal regulativo de la experiencia moral, algo a lo que la razón apunta pero nunca llega.
Full Text Available Elderly people constitute an increasing proportion of those presenting with acute upper gastrointestinal bleeding. Not only in upper gastrointestinal bleeding is advanced age a risk of death, but also exceeding 60 years of age results in an increased risk of cerebrovascular and cardiovascular events. Factors likely to influence the morbidity and mortality associated with endoscopy in an elderly cohort with acute gastrointestinal bleeding include the acuity and severity of bleeding and the presence of comorbid conditions. Audits have shown a surprisingly high incidence of both morbidity and mortality following upper gastrointestinal endoscopy. The following incident is a case report of a cerebrovascular accident following diagnostic upper gastrointestinal endoscopy for an elderly patient with acute upper gastrointestinal bleeding.
Triantafyllou, Konstantinos; Beintaris, Iosif; Dimitriadis, George D
Colon capsule endoscopy is recommended in Europe alternatively to colonoscopy for colorectal cancer screening in average risk individuals. The procedure has also been proposed to complete colon examination in cases of incomplete colonoscopy or when colonoscopy is contraindicated or refused by the patient. As tissue samples cannot be obtained with the current capsule device, colon capsule endoscopy has no place in diagnosing ulcerative colitis or in dysplasia surveillance. Nevertheless, data are accumulating regarding its feasibility to examine ulcerative colitis disease extent and to monitor disease activity and mucosal healing, even though reported results on the capsule's performance in this field vary greatly. In this review we present the currently available evidence for the use of colon capsule endoscopy to complement colonoscopy failure to reach the cecum and its use to evaluate ulcerative colitis disease activity and extent. Moreover, we provide an outlook on issues requiring further investigation before the capsule becomes a mainstream alternative to colonoscopy in such cases.
Holm, C; Rosenberg, J
A high proportion of the mortality and morbidity associated with endoscopic procedures may be of cardiopulmonary origin. For this reason, the appropriate degree of monitoring and prophylactic measures to be used in the sedated patient undergoing endoscopy has become a topic of discussion during...... recent years. The development of myocardial ischaemia during gastrointestinal endoscopy has traditionally been considered to be due to the simultaneous arterial hypoxaemia; however, recent investigations have suggested that tachycardia may be a more important pathogenic factor. No study has ever shown...... that pulse oximetry monitoring or supplemental oxygen will reduce the morbidity or mortality during gastrointestinal endoscopy. The current guidelines for monitoring and oxygen therapy are therefore not supported by scientific data. There is a need for further studies on the pathogenic mechanisms...
@@ This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed by using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data exist from well-designed prospective trials, emphasis is placed on results from large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines are drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline.
van der Wiel, S E; Küttner Magalhães, R; Rocha Gonçalves, Carla Rolanda; Dinis-Ribeiro, M; Bruno, M J; Koch, A D
Simulator-based gastrointestinal endoscopy training has gained acceptance over the last decades and has been extensively studied. Several types of simulators have been validated and it has been demonstrated that the use of simulators in the early training setting accelerates the learning curve in acquiring basic skills. Current GI endoscopy simulators lack the degree of realism that would be necessary to provide training to achieve full competency or to be applicable in certification. Virtual Reality and mechanical simulators are commonly used in basic flexible endoscopy training, whereas ex vivo and in vivo models are used in training the most advanced endoscopic procedures. Validated models for the training of more routine therapeutic interventions like polypectomy, EMR, stenting and haemostasis are lacking or scarce and developments in these areas should be encouraged.
Mittal, B.R.; Ibrarullah, Mohammad; Agarwal, D.K.; Maini, Atul; Ali, Wasif; Sikora, S.S.; Das, B.K. (Sanjay Gandhi Postgraduate Inst. of Medical Sciences (India))
Duodenogastric reflux, the reflux of duodenal bile into stomach, when suspected clinically requires an objective evaluation for proper management. In this study hepatobiliary scintigraphy in 91 patients of different clinical conditions was evaluated for presence of duodenogastric reflux. Upper gastrointestinal endoscopy was also performed in 44 of these patients. On scintigraphy duodenogastric reflux was present in 26 (29%) of 91 patients. Upper gastrointestinal endoscopy revealed presence of refluxed bile in the stomach in 12 (27%) of 44 patients. In the same groups of patients scintigraphy detected reflux in 18 (41%) of 44 patients. This shows that hepatobiliary scintigraphy is superior to upper gastrointestinal endoscopy in detection of duodenogastric reflux and also has the advantage of being non-invasive and physiological. (author).
Ono, Satoshi; Fujishiro, Mitsuhiro; Kodashima, Shinya; Minatsuki, Chihiro; Hirano, Kosuke; Niimi, Keiko; Goto, Osamu; Yamamichi, Nobutake; Koike, Kazuhiko
Guidelines on the management of anticoagulants and antiplatelet agents for endoscopy were established by Japan Gastroenterological Endoscopy Society (JGES) in 2005. However, the permeation of the JGES guideline is reported to possibly be low. One of the important causes of this problem is the confusing situation of gaps between the guidelines of various societies. Additionally, our ongoing investigation has revealed another important cause, which is the current daily clinical practice that cessation periods before endoscopy were determined by non-gastroenterological specialists who might be unfamiliar with the JGES guidelines. Considering the low permeation of the guidelines for non-gastroenterological specialists prescribing these agents, we propose that close coordination between various specialists is mandatory to fill the gap between endoscopists and non-gastroenterological specialists.
Uedo, Noriya; Yao, Kenshi
Although dye-based and image-enhanced endoscopic techniques have revolutionized endoscopic diagnosis, conventional white light endoscopy still plays an important role in the diagnosis of early gastric cancer (EGC) during routine endoscopy. Chromoendoscopy reveals morphological characteristics of the mucosal lesions by enhancing mucosal contrast, while narrow-band imaging (NBI) facilitates detailed evaluation of the vascular architecture and surface features. Positive diagnostic findings of EGC on white light imaging and indigo carmine chromoendoscopy are a sharply demarcated lesion and irregularity in surface morphology or color. Magnifying NBI further improves diagnostic accuracy of white light imaging and chromoendoscopy. We review our approach to the endoscopic diagnosis of (pre-)malignant lesions in the stomach and discuss in detail novel endoscopic microvascular architectural patterns which further leverage diagnostic biopsy yield. We expect that further improvement of endoscopic techniques and correlative studies will close the gap between endoscopy and pathology.
Perbtani, Yaseen B; Summerlee, Robert J; Yang, Dennis; An, Qi; Suarez, Alejandro; Williamson, J Blair; Shrode, Charles W; Gupte, Anand R; Chauhan, Shailendra S; Draganov, Peter V; Forsmark, Chris E; Chang, Myron; Wagh, Mihir S
Measures for evaluating interventional endoscopy unit efficiency have not been adequately validated, especially in reference to the involvement of anesthesia services for endoscopy. Primary aim was to compare process measures/metrics of interventional endoscopy unit efficiency between intubated and non-intubated patients. Secondary aim was to assess variables associated with the need for endotracheal intubation. The prospectively collected endoscopy unit metrics database at UF Health was reviewed for procedures performed in the interventional endoscopy unit for 6 months. Parameters included hospital-mandated metrics available from the database. A total of 1,421 patients underwent 1,635 interventional endoscopic procedures and 271/1,421 patients (19.1%) were intubated. There was no significant difference between intubated and non-intubated cohorts with respect to age, gender, BMI, ASA Score, Mallampati Score, or the Charlson Comorbidity Index. Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were more frequently intubated than those undergoing non-ERCP procedures (41.3 vs. 12.4%, Pintubated patients, whereas only 29.2% of non-intubated patients were inpatients (Pintubated per anesthesiologist preference. All process efficiency metrics were significantly prolonged in the intubated compared with the non-intubated patient cohort, except the time interval between successive procedures. Multivariate analysis revealed that patients with an anesthesiologist who had performed a greater number of total endoscopic sedations were less likely to be intubated than patients with an anesthesiologist who had performed fewer total procedures (P=0.0066). Endotracheal intubation negatively impacts efficiency metrics in an interventional endoscopy unit. Careful assessment for the need for intubation should be emphasized.
Hollier, John M; Hinojosa-Lindsey, Marilyn; Sansgiry, Shubhada; El-Serag, Hashem B; Naik, Aanand D
Many patients with Barrett's esophagus do not adhere to guideline-recommended endoscopic surveillance. Among patient factors related to cancer prevention behaviors, patients' stated behavioral intention is a strong predictor of behavior performance. Little is known about the patient factors associated with having a strong behavioral intention to pursue surveillance endoscopy. This study explores the association of clinical and psychosocial variables and behavioral intention to pursue surveillance endoscopy among patients with Barrett's Esophagus and no or low-grade dysplasia. Potential subjects were screened using electronic medical records of a regional Veterans Affairs Medical Center and a pathologically confirmed Barrett's esophagus registry. Eligible participants were recruited by a mailer or phone call and completed a questionnaire to measure six distinct psychosocial factors, their behavioral intention to undergo surveillance endoscopy, and various demographic and clinical variables. Univariate and multivariate linear regression identified the relation of behavioral intention with each of six psychosocial variables. One-hundred and one subjects consented and returned surveys. The analytical sample for this study consists of the 94% of surveys with complete responses to the behavior intention items. Three of the six psychosocial domains were statistically significant predictors of intention in both univariate and adjusted univariate analysis (salience/coherence β = 0.59, 95% CI = 0.45-0.76, P intention. This study established the validity of a scale to measure psychosocial variables associated with behavioral intentions to undergo surveillance endoscopy. Results demonstrate the importance of assessing self-efficacy, social influences, and bottom-line belief in the value of surveillance endoscopy when evaluating a patient's likelihood of completing surveillance endoscopy.
Ristikankare, Matti; Hartikainen, Juha; Heikkinen, Markku; Julkunen, Risto
Upper endoscopy is an invasive procedure. However, the benefits of routinely administered sedative medication or topical pharyngeal anesthesic are controversial. The aim of this study was to clarify their effects on patient tolerance and difficulty of upper endoscopy. A total of 252 patients scheduled for diagnostic upper endoscopy were randomly assigned to 4 groups: (1) sedation with midazolam and placebo pharyngeal spray (midazolam group), (2) placebo sedation and lidocaine pharyngeal spray (lidocaine group), (3) placebo sedation and placebo pharyngeal spray (placebo group), and (4) no intravenous cannula/pharyngeal spray (control group). The endoscopist and the patient assessed the procedure immediately after the examination. Another questionnaire was sent to the patients 2 weeks later. Patients in the midazolam group rated the examination easier and less uncomfortable compared with those in the other groups. The differences were especially evident in the questionnaires completed 2 weeks after the examination ( p < 0.001). Lidocaine did not significantly improve patient tolerance. However, endoscopists found the procedure easier in patients in the lidocaine group compared with the midazolam ( p < 0.01) and control groups ( p < 0.01) but not the placebo group. Routine administration of midazolam for sedation increased patient tolerance for upper endoscopy. However, endoscopists found intubation to be more difficult in sedated vs. non-sedated patients. Topical pharyngeal anesthesia did not enhance patient tolerance, but it did make upper endoscopy technically easier compared with endoscopy in patients sedated with midazolam without topical pharyngeal anesthesia, and in patients who had no sedation or pharyngeal anesthesia, but not in patients who received placebo sedation and placebo pharyngeal anesthesia.
Tiing-Leong Ang; Kwong-Ming Fock; Tay-Meng Ng; Eng-Kiong Teo; Yi-Lyn Tan
AIM:Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western studies. In this prospective study, we aimed to determine the clinical utility, safety and tolerability of capsule endoscopy in the evaluation of suspected small bowel disease in an urban Southeast Asian population.METHODS: We used the given (M2A) capsule endoscopy system in 16 consecutive patients with suspected small bowel pathology. In 9 patients the indication was obscure gastrointestinal bleeding, while in 6 patients it was to determine the extent of small bowel involvement in Crohn's disease. One patient underwent capsule endoscopy for evaluation of chronic abdominal pain. Patient's tolerability to the procedure was evaluated by standardized questionnaires and all patients were reviewed at one week to ensure that the capsule had been excreted without any adverse events.RESULTS: Abnormal findings were present in 8 patients (50%). The cause of obscure gastrointestinal bleeding was determined in 5 out of 9 patients. Findings included 2 cases of angiodysplasia, 2 cases of jejunal ulcers and 1 case of both angiodysplasia and jejunal ulcer. One patient had small bowel erosions and foci of erythema of doubtful significance.Ileal lesions were diagnosed in 2 out of 6 patients with Crohn's disease. Capsule endoscopy was well tolerated by all patients. One patient with Crohn's disease had a complication of capsule retention due to terminal ileum stricture. The capsule eventually passed out spontaneously after 1 month.CONCLUSION: Our study, which represented the first Asian series, further confirms the diagnostic utility, safety and tolerability of wireless capsule endoscopy.
Full Text Available Upper endoscopy is a common procedure for the diagnosis and treatment of upper digestive tract diseases. The increasing number of pediatric gastrointestinal procedures has led to increasing attention on the safety and efficacy of medications used for sedation during the procedure. This randomized blinded interventional study was designed to compare the effect of oral midazolam with intravenous (IV midazolam as a sedative medication in 119 children undergoing endoscopy. The mean time to sedation was 2.2±0.7 in IV midazolam group and 30.9±0 in oral midazolam group which was statistically significant difference between two groups. Separation from parents in oral midazolam group was as follow: 2 patients were high resistant (3.5%, 2 patients were resisted first and then relaxed (3.5% and 55 patients were separated from their parents without any resistance (93%; whereas in IV midazolam group, 8 patients were high resistant (13.3%, 29 patients were relatively resistant (48.3% and 23 patients were separated from their parents without any resistance (38.3% that shows significant differences between the two groups. In terms of patient comfort during endoscopy, there was also a significant difference between the two groups. In oral midazolam, group parents were more consent, compared with the other group. The present study showed that oral midazolam is a safe and effective sedation during upper endoscopy in pediatrics. Oral midazolam reducing patients' anxiety during separation from parents leads the easy use of endoscopy and comfort of patients during endoscopy as compared with IV midazolam. Oral or IV midazolam were not able to put most patients in deep sedation level.
Sami, S S; Subramanian, V; Butt, W M; Bejkar, G; Coleman, J; Mannath, J; Ragunath, K
High-definition endoscopy systems provide superior image resolution. The aim of this study was to assess the utility of high definition compared with standard definition endoscopy system for detecting dysplastic lesions in patients with Barrett's esophagus. A retrospective cohort study of patients with non-dysplastic Barrett's esophagus undergoing routine surveillance was performed. Data were retrieved from the central hospital electronic database. Procedures performed for non-surveillance indications, Barrett's esophagus Prague C0M1 classification with no specialized intestinal metaplasia on histology, patients diagnosed with any dysplasia or cancer on index endoscopy, and procedures using advanced imaging techniques were excluded. Logistic regression models were constructed to estimate adjusted odds ratios and 95% confidence intervals comparing outcomes with standard definition and high-definition systems. The high definition was superior to standard definition system in targeted detection of all dysplastic lesions (odds ratio 3.27, 95% confidence interval 1.27-8.40) as well as overall dysplasia detected on both random and target biopsies (odds ratio 2.36, 95% confidence interval 1.50-3.72). More non-dysplastic lesions were detected with the high-definition system (odds ratio 1.16, 95% confidence interval 1.01-1.33). There was no difference between high definition and standard definition endoscopy in the overall (random and target) high-grade dysplasia or cancers detected (odds ratio 0.93, 95% confidence interval 0.83-1.04). Trainee endoscopists, number of biopsies taken, and male sex were all significantly associated with a higher yield for dysplastic lesions. The use of the high-definition endoscopy system is associated with better targeted detection of any dysplasia during routine Barrett's esophagus surveillance. However, high-definition endoscopy cannot replace random biopsies at present time.
Khodadad, Ahmad; Aflatoonian, Majid; Jalilian, Rozita; Babaei, Nazanin; Motamed, Farzaneh; Ebrahime Soltani, Alireza; Rasoolzadeh, Behnaz; Motavasselian, Fatemeh; Rezaei, Nima
Upper endoscopy is a common procedure for the diagnosis and treatment of upper digestive tract diseases. The increasing number of pediatric gastrointestinal procedures has led to increasing attention on the safety and efficacy of medications used for sedation during the procedure. This randomized blinded interventional study was designed to compare the effect of oral midazolam with intravenous (IV) midazolam as a sedative medication in 119 children undergoing endoscopy. The mean time to sedation was 2.2±0.7 in IV midazolam group and 30.9±0 in oral midazolam group which was statistically significant difference between two groups. Separation from parents in oral midazolam group was as follow: 2 patients were high resistant (3.5%), 2 patients were resisted first and then relaxed (3.5%) and 55 patients were separated from their parents without any resistance (93%); whereas in IV midazolam group, 8 patients were high resistant (13.3%), 29 patients were relatively resistant (48.3%) and 23 patients were separated from their parents without any resistance (38.3%) that shows significant differences between the two groups. In terms of patient comfort during endoscopy, there was also a significant difference between the two groups. In oral midazolam, group parents were more consent, compared with the other group. The present study showed that oral midazolam is a safe and effective sedation during upper endoscopy in pediatrics. Oral midazolam reducing patients' anxiety during separation from parents leads the easy use of endoscopy and comfort of patients during endoscopy as compared with IV midazolam. Oral or IV midazolam were not able to put most patients in deep sedation level.
Pedro BOAL CARVALHO
Full Text Available ABSTRACT BACKGROUND Small bowel bleeding is a leading indication for small bowel capsule endoscopy. The Suspected Blood Indicator (SBI is a software feature directed to automatically detect bleeding lesions during small bowel capsule endoscopy. OBJECTIVE We aimed to assess SBI diagnostic accuracy for small bowel haemorrhage or potentially bleeding lesions during small bowel capsule endoscopy for small bowel bleeding. Methods - Single-centre retrospective study including 281 consecutive small bowel capsule endoscopy performed for small bowel bleeding during 6 years. The investigators marked lesions with high bleeding potential (P2, such as angioectasias, ulcers and tumours, as well as active bleeding during regular small bowel capsule endoscopy viewing with PillCam SB2(r. All small bowel capsule endoscopy were independently reviewed by another central reader using SBI. RESULTS Among the 281 patients, 29 (10.3% presented with active haemorrhage while 81 (28.9% presented with a P2 lesion. The most frequently observed P2 lesions were angioectasias (52, ulcers (15, polyps (7 and ulcerated neoplasias (7. SBI showed a 96.6% (28/29 sensitivity for active small bowel bleeding, with a 97.7% negative predictive value. Regarding P2 lesions, the SBI displayed an overall sensitivity of 39.5%, being highest for ulcerated neoplasias (100%, but significantly lower for angioectasias (38.5% or ulcers (20.0%. CONCLUSION Although SBI sensitivity for the automatic detection of potentially bleeding lesions was low, it effectively detected active small bowel bleeding with very high sensitivity and negative predictive value.
Rey, J F; Beilenhoff, U; Neumann, C S; Dumonceau, J M
Electrosurgery is used in the majority of endoscopic therapeutic procedures. An understanding of the fundamental electrosurgical principles and various settings available on electrosurgical units is essential for the safe and effective use of electrosurgery during endoscopy. The aims of these technical guidelines are to: (1) expose physical principles relevant to the understanding of electrosurgery during endoscopy; (2) describe and provide practical recommendations regarding electrosurgical units that are commonly in use; (3) discuss the clinical relevance of technologies recently implemented in newer electrosurgical units; and (4) review factors relevant to commonly performed therapeutic procedures, including polypectomy, sphincterotomy, contact thermal hemostasis, and argon plasma coagulation.
Hoo-Yeon; Lee; Eun-Cheol; Park; Jae; Kwan; Jun; Kui; Son; Choi; Myung-Il; Hahm
AIM:To compare the cost and accuracy of upper gastrointestinal(GI)X-ray and upper endoscopy for diagnosis of gastric cancer using data from the 2002-2004 Korean National Cancer Screening Program(NCSP). METHODS:The study population included 1 503 646 participants in the 2002-2004 stomach cancer screening program who underwent upper GI X-ray or endoscopy.The accuracy of screening was defined as the probability of detecting gastric cancer.We calculated the probability by merging data from the NCSP and the Kore...
Alexander; Link; Gerhard; Treiber; Brigitte; Peters; Thomas; Wex; Peter; Malfertheiner
AIM:To study the impact of an endoscopy-based long-term study on the quality of life in healthy volunteers(HV).METHODS:Ten HV were included into a long-term prospective endoscopy-based placebo-controlled trial with 15 endoscopic examinations per person in 5 different drug phases.Participants completed short form-36(SF-36) and visual analog scale-based questionnaires(VAS) for different abdominal symptoms at days 0,7 and 14 of each drug phase.Analyses wereperformed according to short-and long-term changes and...
Boor, S; Resch, K M; Perneczky, A; Stoeter, P
Virtual endoscopy (VE) is a postprocessing technique based on a diverging ray casting algorithm to create perspective 3 D-images from computed tomographic angiography (CTA) and high resolution magnetic resonance imaging (MR) data. By applying VE to aneurysms, tumors, and vascular compression syndromes within the basal cisterns, endoscopic-like views of these structures are achieved from an intracisternal point above the cranial base. These views closely simulate the surgeon's impression during intraoperative endoscopy or microscopy and facilitate preoperative planning of different approaches.
Benoist, L B L; de Vries, N
Drug-induced sleep endoscopy (DISE) is a rapidly growing method to evaluate airway collapse in patients receiving non-CPAP therapies for sleep-disordered breathing (SDB). The growing number of DISEs has consequences for the organization of clinical protocols. In this paper we present our recent experiences with DISE, performed by an ENT resident, with sedation given by a nurse anesthetist, in an outpatient endoscopy setting, while the staff member/sleep surgeon discusses the findings and the recommended treatment proposal on the same day.
Full Text Available There is no consensus on the timing and management of emergency overt obscure gastrointestinal bleeding. Emergency capsule endoscopy and balloon-assisted enteroscopy have a high diagnostic and therapeutic yield in these situations. Most lesions detected by small bowel endoscopy are amenable to endoscopic haemostasis, although some lesions still require surgery or interventional radiology. The management of these patients is varied, and doubt persists about which technique should be preferred as first-line treatment. This narrative review analyses the usefulness and impact of small bowel endoscopic techniques in the emergency setting for severe overt obscure gastrointestinal bleeding.
Artifon, Everson L A; Tchekmedyian, Asadur J; Fernandes, Kaie; Artifon, Aline N; Fonseca, Alvaro; Otoch, Jose P
In recent decades, the traditional teaching model of gastrointestinal endoscopy has been based on the teacher-student tutorial method based on theoretical models. Today, simulators have the advantages of virtual reality. The handling apparatus is similar to that used in clinical practice; it is safe, which allows unlimited use, cost-effective for institutions and with superior performance over other training models. Besides, biological simulators are a viable, accessible and affordable tool to simulate gastrointestinal lesions, allowing training in endoscopy with a high degree of similarity in the endoscopic appearance. In this review, we analyze both models, showing its advantages for the training of the endoscopist of the times.
Khajanchee, Y S; Cassera, M A; Swanström, L L; Dunst, C M
Sliding Type-I hiatal hernia is commonly diagnosed using upper endoscopy, barium swallow or less commonly, esophageal manometry. Current data suggest that endoscopy is superior to barium swallow or esophageal manometry. Recently, high-resolution manometry has become available for the assessment of esophageal motility. This novel technology is capable of displaying spatial and topographic pressure profiles of gastroesophageal junction and crural diaphragm in real time. The objective of the current study was to compare the specificity and sensitivity of high-resolution manometry and endoscopy in the diagnosis of sliding hiatal hernia in patients with gastroesophageal reflux disease. Data were analyzed retrospectively for 83 consecutive patients (61% females, mean age 52 ± 13.2 years) with objective gastroesophageal reflux disease who were considered for laparoscopic antireflux surgery between January 2006 and January 2009 and had preoperative high-resolution manometry and endoscopy. Manometrically, hiatal hernia was defined as separation of the gastroesophageal junction >2.0 cm from the crural diaphragm. Intraoperative diagnosis of hiatal hernia was used as the gold standard. Sensitivity, specificity and likelihood ratios of a positive test and a negative test were used to compare the performance of the two diagnostic modalities. Forty-two patients were found to have a Type-I sliding hiatal hernia (>2 cm) during surgery. Twenty-two patients had manometric criteria for a hiatal hernia by high-resolution manometry, and 36 patients were described as having a hiatal hernia by preoperative endoscopy. False positive results were significantly fewer (higher specificity) with high-resolution manometry as compared with endoscopy (4.88% vs. 31.71%, P= 0.01). There were no significant differences in the false negative results (sensitivity) between the two diagnostic modalities (47.62% vs. 45.24%, P= 0.62). Analysis of likelihood ratios of a positive and negative test
Clere-Jehl, Raphaël; Sauleau, Erik; Ciuca, Stefan; Schaeffer, Mickael; Lopes, Amanda; Goichot, Bernard; Vogel, Thomas; Kaltenbach, Georges; Bouvard, Eric; Pasquali, Jean-Louis; Sereni, Daniel; Andres, Emmanuel; Bourgarit, Anne
Abstract After the age of 65 years, iron deficiency anemia (IDA) requires the elimination of digestive neoplasia and is explored with upper and lower gastrointestinal (GI) endoscopy. However, such explorations are negative in 14% to 37% of patients. To further evaluate this issue, we evaluated the outcomes of patients aged over 65 years with endoscopy-negative IDA. We retrospectively analyzed the outcomes of in-patients over the age of 65 years with IDA (hemoglobin <12 g/dL and ferritin <70 μg/L) who had negative complete upper and lower GI endoscopies in 7 tertiary medical hospitals. Death, the persistence of anemia, further investigations, and the final diagnosis for IDA were analyzed after at least 12 months by calling the patients’ general practitioners and using hospital records. Between 2004 and 2011, 69 patients (74% women) with a median age of 78 (interquartile range (IQR) 75–82) years and hemoglobin and ferritin levels of 8.4 (IQR 6.8–9.9) g/dL and 14 (IQR 8–27) μg/L, respectively, had endoscopy-negative IDA, and 73% of these patients received daily antithrombotics. After a follow-up of 41 ± 22 months, 23 (33%) of the patients were dead; 5 deaths were linked with the IDA, and 45 (65%) patients had persistent anemia, which was significantly associated with death (P = 0.007). Further investigations were performed in 45 patients; 64% of the second-look GI endoscopies led to significant changes in treatment compared with 25% for the capsule endoscopies. Conventional diagnoses of IDA were ultimately established for 19 (27%) patients and included 3 cancer patients. Among the 50 other patients, 40 (58%) had antithrombotics. In endoscopy-negative IDA over the age of 65 years, further investigations should be reserved for patients with persistent anemia, and second-look GI endoscopy should be favored. If the results of these investigations are negative, the role of antithrombotics should be considered. PMID:27893668
Rajiv K Chander
Full Text Available The patient is a 39-year-old male with a five-month history of progressive dysphagia and a 70 lb weight loss. On upper gastrointestinal (GI endoscopy he was found to have a near-obstructing mass in the lower oesophagus that was proven by biopsy to be oesophageal adenocarcinoma. Stricture caused by the adenocarcinoma mass was stented with a Cook Evolution 12.5 cm / 24 Fr stent, which dislodged subsequently. We report the first case of a dislodged Cook Evolution 12.5 cm / 24 Fr oesophageal stent that was retrieved using combined laparoscopic and transabdominal endoscopy.
Crespo Estrada, Miriam Caridad; Sanabria Ortega, Karen; Guerra Astorga, Carlos
.... El trabajo que se presenta muestra la evolucion de la ensenanza de la Matematica en la formacion de arquitectos, asi como experiencias pedagogicas de integracion especificas con la disciplina Expresion Grafica...
Noboru Yoshimura; Kenichi Goda; Hisao Tajiri; Yukinaga Yoshida; Takakuni Kato; Yoichi Seino; Masahiro Ikegami; Mitsuyoshi Urashima
AIM: To investigate the endoscopic features of pha-ryngeal superficial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease.METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) en-doscopy and non-magnified/magnified NBI endoscopy, followed by an endoscopic biopsy, for 445 superficial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superficial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defined as a superficial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnified/ magnified NBI endoscopy. An experienced pathologist who was unaware of the endoscopic findings made the histological diagnoses. By comparing endoscopic findings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI.RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neo-plasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classified as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was significantly greater than that of non-SC lesions (11.0 7.6 mm vs 4.6 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy findings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P< 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in
Kaushal, Neal K; Chang, Kenneth; Lee, John G; Muthusamy, V Raman
With an increasing demand for endoscopy services, there is a greater need for efficiency within the endoscopy center. A validated methodology is important for evaluating efficiency in the endoscopy unit. To use the principles of operations management to establish a validated methodology for evaluating and enhancing operational performance in the endoscopy center. Biphasic prospective study with pre-intervention and post-intervention efficiency data and analysis. Tertiary-care referral teaching hospital. Scheduled outpatients undergoing endoscopy. Determination of the rate-limiting step, or bottleneck, of the endoscopy unit and reducing inefficiencies. Staffing costs and a novel performance metric, True Completion Time (TCT). Data were prospectively recorded for 2248 patients undergoing a total of 2713 procedures (phase I: 255 EGD, 305 colonoscopy, 91 EGD/colonoscopy, 375 EUS, 44 ERCP, 75 EUS/ERCP; phase II: 243 EGD, 328 colonoscopy, 99 EGD/colonoscopy, 335 EUS, 38 ERCP, 109 EUS/ERCP). The bottleneck of the operation was identified as the 10-bed communal pre-procedure/recovery room. On-time procedure starts increased by 51% (P costs were reduced by 30%, whereas full-time employee staff was reduced by 0.85. Annual cost savings were calculated as $312,618 or 11.02% of total operating expenses. This study is not directly tied to quality outcomes, and inpatient procedures transported to the endoscopy unit were not directly studied. Room turnover time and room-to-endoscopist ratio are not necessarily the driving parameters behind endoscopy unit efficiency. A focus on developing a methodology for identifying factors constraining operational efficiency can improve performance and reduce costs in the endoscopy center. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Kjeldsen, Hans Christian; Lauritzen, Torsten; Christensen, Bo
Background: Decision analyses conclude that empirical anti-secretory therapy is more cost-effective than endoscopy for managing patients with dyspepsia however RCTs including economic evaluation come to diverging results Aim: to compare the cost-effectiveness of two strategies for management of...
Halling, Morten Lee; Nathan, Torben; Kjeldsen, Jens
Capsule endoscopy (CE) has a high sensitivity for diagnosing small bowel Crohn's disease, but video analysis is time consuming. The quick view (qv) function is an effective tool to reduce time consumption. The aim of this study was to determine the rate of missed small bowel ulcerations with qv...
Craenen, E. M. E.; Hofker, Hendrik; Peters, Frans; Kater, G. M.; Glatman, K. R.; Zijlstra, J. G.
Introduction: Recurrent bleeding from an upper gastrointestinal ulcer when endoscopy fails is a reason for radiological or surgical treatment, both of which have their advantages and disadvantages. Case: Based on a patient with recurrent gastrointestinal bleeding, we reviewed the available evidence
Full Text Available Meckel’s diverticulum (MD is the most common congenital anomaly of the gastrointestinal (GI tract, affecting about 2% of the population. Most cases of Meckel’s diverticula are asymptomatic. The diagnosis of symptomatic MD is often difficult to make. We report the case of an 8-year-old boy who presented with GI bleeding due to MD. The diagnostic difficulties after an initial negative endoscopic evaluation and the diagnostic value of the various endoscopic procedures are discussed. The patient had suffered from bright red stools for 20 h before hospital admission. GI scintigraphy with 99mTc-Na-pertechnetate was negative for heterotopic gastric tissue in the small bowel area. Colonoscopy performed in order to exclude Crohn’s disease was also negative. He was placed on ranitidine at a dose of 6 mg/kg body weight twice daily. The patient remained asymptomatic over a period of 6 months before he was readmitted due to macroscopic rectal bleeding. Upper endoscopy and colonoscopy used to investigate the source of bleeding showed normal macroscopic findings. Radiolabeling of blood constituents with 99mTc on delayed imaging showed radionucleotide concentration in the ascending and transverse colon suggestive of a lesion in the ileocecal area. Further investigation with the use of wireless capsule endoscopy revealed a MD. Wireless capsule endoscopy may thus be indicated for patients with GI blood loss when other diagnostic methods, such as upper and lower endoscopy and colonoscopy, have failed to identify the source of bleeding.
Park, Chan Hyuk; Han, Dong Soo; Jeong, Jae Yoon; Eun, Chang Soo; Yoo, Kyo-Sang; Jeon, Yong Cheol; Sohn, Joo Hyun
Although propofol-based sedation can be used during emergency endoscopy for upper gastrointestinal bleeding (UGIB), there is a potential risk of sedation-related adverse events, especially in patients with variceal bleeding. We compared adverse events related to propofol-based sedation during emergency endoscopy between patients with non-variceal and variceal bleeding. Clinical records of patients who underwent emergency endoscopy for UGIB under sedation were reviewed. Adverse events, including shock, hypoxia, and paradoxical reaction, were compared between the non-variceal and variceal bleeding groups. Of 703 endoscopies, 539 and 164 were performed for non-variceal and variceal bleeding, respectively. Shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding (12.2 vs. 3.5%, P bleeding (non-variceal bleeding vs. variceal bleeding: hypoxia, 3.5 vs. 1.8%, P = 0.275; paradoxical reaction interfering with the procedure, 4.1 vs. 5.5%, P = 0.442). Although shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding, most cases could be controlled without procedure interruption. Paradoxical reaction, rather than shock or hypoxia, was the most common cause of procedure interruption in patients with variceal bleeding, but the rate did not differ between patients with non-variceal and variceal bleeding.
Na, Hee Kyong; Jung, Hwoon-Yong; Seo, Dong Woo; Lim, Hyun; Ahn, Ji Yong; Lee, Jeong Hoon; Kim, Do Hoon; Choi, Kee Don; Song, Ho June; Lee, Gin Hyug; Kim, Jin-Ho
The aim of this study was to compare the effects of erythromycin infusion and gastric lavage in order to improve the quality of visualization during emergency upper endoscopy. We performed a prospective randomized pilot study. Patients presented with hematemesis or melena within 12 hours and were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin + gastric lavage group (both erythromycin infusion and gastric lavage). The primary outcome was satisfactory visualization. Secondary outcomes included identification of a bleeding source, the success rate of hemostasis, duration of endoscopy, complications related to erythromycin infusion or gastric lavage, number of transfused blood units, rebleeding rate, and bleeding-related mortality. A total of 43 patients were randomly assigned: 14 patients in the erythromycin group; 15 patients in the gastric lavage group; and 14 patients in the erythromycin + gastric lavage group. Overall satisfactory visualization was achieved in 81% of patients: 92.8% in the erythromycin group; 60.0% in the gastric lavage group; and 92.9% in the erythromycin + gastric lavage group, respectively (p = 0.055). The identification of a bleeding source was possible in all cases. The success rate of hemostasis, duration of endoscopy, and number of transfused blood units did not significantly differ between groups. There were no complications. Rebleeding occurred in three patients (7.0%). Bleeding-related mortality was not reported. Intravenous erythromycin infusion prior to emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding seems to provide satisfactory endoscopic visualization.
Wierzchowski, Pawel; Dabrowiecki, Stanislaw; Szczesny, Wojciech; Szmytkowski, Jakub
Upper gastrointestinal tract bleeding (UGIB) remains a valid issue of modern medicine. The mortality and recurrence rates remain high and have not decreased as expected over the past decades. to assess the treatment outcomes of nonvariceal UGIB depending on the timing of endoscopy (urgent vs. elective) and to perform an analysis of risk factors for death in patients with nonvariceal UGIB. Comparative evaluation of treatment outcomes in two groups of patients. Group A consisted of patients undergoing elective endoscopy (n = 187). Group B consisted of patients undergoing emergency endoscopy (n = 295). Moreover, the influence of selected factors on the risk of death and bleeding recurrence was analyzed in the combined population of the two groups. This was done by constructing a logistic regression model and testing dependence hypotheses. In group A the mortality rate was 9.1%, and the recurrence rate was 18.2%. In group B the values were 6.8% and 12.2%, respectively. No statistically significant difference was found (p = NS). In group B the number of surgical interventions, blood transfusions and intensive care admissions was significantly lower (p bleeding from a malignant lesion, recurrent bleeding and the need for surgery (p < 0.05). The use of emergency endoscopy improves the treatment outcomes in patients with UGIB, although no statistically significant decrease in the mortality and recurrence rates could be observed.
Kring, Thomas S; Piper, Thomas B; Jørgensen, Lars N;
Soluble cancer-related protein biomarker levels may be increased in subjects without findings at large bowel endoscopy performed due to symptoms associated with colorectal cancer. The present study focused on a possible association between increased biomarker levels in such subjects and subsequen...
Jensen, Michael Dam; Nathan, Torben; Kjeldsen, Jens
OBJECTIVE: Compared to other modalities, capsule endoscopy (CE) has a high diagnostic yield for diagnosing small bowel Crohn's disease (CD). The aim of this study was to determine the inter-observer agreement for detection of small bowel CD with predefined diagnostic criteria. MATERIAL AND METHODS...
Renée M. Janssen
Full Text Available Objective. The Canadian Association of Gastroenterology Wait Time Consensus Group recommends that patients with symptoms associated with colorectal cancer (CRC should have an endoscopic examination within 2 months. However, in a recent survey of Canadian gastroenterologists, wait-times for endoscopy were considerably longer than the current guidelines recommend. The purpose of this study was to evaluate wait-times for colonoscopy in patients who were subsequently found to have CRC through the Division of Gastroenterology at St. Paul’s Hospital (SPH. Methods. This study was a retrospective chart review of outpatients seen for consultation and endoscopy ultimately diagnosed with CRC. Subjects were identified through the SPH pathology database for the inclusion period 2010 through 2013. Data collected included wait-times, subject characteristics, cancer characteristics, and outcomes. Results. 246 subjects met inclusion criteria for this study. The mean wait-time from primary care referral to first office visit was 63 days; the mean wait-time to first endoscopy was 94 days. Patients with symptoms waited a mean of 86 days to first endoscopy, considerably longer than the national recommended guideline of 60 days. There was no apparent effect of length of wait-time on node positivity or presence of distant metastases at the time of diagnosis. Conclusion. Wait-times for outpatient consultation and endoscopic evaluation at the St. Paul’s Hospital Division of Gastroenterology exceed current guidelines.
Salale, Nesrin; Treldal, Charlotte; Mogensen, Stine;
Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult...... with a lidocaine spray proved to be a superior option as topical pharyngeal anesthetic before an UGE....
Mostafa, Atahar; Khan, Tareq; Wahid, Khan
Video capsule endoscopy is a non-invasive technique to receive images of intestine for medical diagnostics. The main design challenges of endoscopy capsule are accruing and transmitting acceptable quality images by utilizing as less hardware and battery power as possible. In order to save wireless transmission power and bandwidth, an efficient image compression algorithm needs to be implemented inside the endoscopy electronic capsule. In this paper, an integer discrete-cosine-transform (DCT) based algorithm is presented that works on a low-complexity color-space specially designed for wireless capsule endoscopy application. First of all, thousands of human endoscopic images and video frames have been analyzed to identify special intestinal features present in those frames. Then a color space, referred as YEF, is used. The YEF converter is lossless and takes only a few adders and shift operation to implement. A low-cost quantization scheme with variable chroma sub-sampling options is also implemented to achieve higher compression. Comparing with the existing works, the proposed transform coding based compressor performs strongly with an average compression ratio of 85% and a high image quality index, peak-signal-to-noise ratio (PSNR) of 52 dB.
Full Text Available BACKGROUND: Supplemental oxygen is routinely given via nasal cannula (NC to patients undergoing moderate sedation for endoscopy. Some patients complain of profuse rhinorrhea and/or sneezing after the procedure, which results in additional medical costs and patient dissatisfaction.
Full Text Available Introduction: Hypoxemia can occur during upper gastrointestinal endoscopy with or without pharmacological sedation. Pulse oximetry saturation (SpO2 levels were assessed in patients attending for routine unsedated diagnostic upper gastrointestinal endoscopy to identify factors associated with oxygen desaturation. Methods: A total of 300 patients who underwent upper gastrointestinal endoscopy without sedation were monitored with continuous pulse oximetry. Factors related to the patient, the examination, and the monitoring data that could predict severe desaturation were evaluated. Results: Mild desaturation (SpO2 between 1-4% was found in 143(47.7% of the patients, while severe desaturation (SpO2≥5% and hypoxemia occurred in 65 (21.7% of patients, 40 (61.5% of those had previous illnesses (p<0.001. The variables found to predict severe desaturation were basal SpO2 <95%, chronic obstructive pulmonary disease, anemia, age more than 60 years and coronary artery disease. Conclusion: The decrease in SpO2 is related to increase in age, basal SaO2 < 95%, respiratory disease, coronary artery disease, and anemia, .We recommend continuous monitoring of SpO2 in these high-risk patients undergoing upper gastrointestinal endoscopy.
Mogensen, Stine; Treldal, Charlotte; Feldager, Erik
To evaluate the effect and acceptance of a new lidocaine lozenge compared with a lidocaine viscous oral solution as a pharyngeal anesthetic before upper gastrointestinal endoscopy (UGE), a diagnostic procedure commonly performed worldwide during which many patients experience severe discomfort mo...
Craenen, E. M. E.; Hofker, Hendrik; Peters, Frans; Kater, G. M.; Glatman, K. R.; Zijlstra, J. G.
Introduction: Recurrent bleeding from an upper gastrointestinal ulcer when endoscopy fails is a reason for radiological or surgical treatment, both of which have their advantages and disadvantages. Case: Based on a patient with recurrent gastrointestinal bleeding, we reviewed the available evidence
Alexander F Hagel
Full Text Available BACKGROUND: Conventional colonoscopy (CC is the gold standard for diagnostic examination of the colon. However, the overall acceptance of this procedure is low due to patient fears of complications or embarrassment. Colon capsule endoscopy (CCE represents a minimally invasive, patient-friendly procedure that offers complete visualization of the entire intestine.
Bouma, H.; Mark, W. van der; Eendebak, P.T.; Landsmeer, S.; Eekeren, A.W.M. van der; Haar, F.B. ter; Wieringa, F.P.; Basten, J.P. van
Compared to open surgery, minimal invasive surgery offers reduced trauma and faster recovery. However, lack of direct view limits space perception. Stereo-endoscopy improves depth perception, but is still restricted to the direct endoscopic field-of-view. We describe a novel technology that reconstr
Filip Janssens; Jacques Deviere; Pierre Eisendrath; Jean-Marc Dumonceau
AIM:To assess the adoption of Carbon dioxide (CO2) insufflation by endoscopists from various European countries, and its determinants. METHODS:A survey was di s t r ibuted to 580 endoscopists attending a live course on digestive endoscopy. RESULTS:The response rate was 24.5%. Fewer than half the respondents (66/142, 46.5%) were aware of the fact that room air can be replaced by CO2 for gut distension during endoscopy, and 4.2% of respondents were actually using CO2 as the insufflation agent. Endoscopists aware of the possibility of CO2 insufflation mentioned technical difficulties in implementing the system and the absence of significant advantages of CO2 in comparison with room air as barriers to adoption in daily practice (84% and 49% of answers, respectively; two answers were permitted for this item). CONCLUSION:Based on this survey, adoption of CO2 insufflation during endoscopy seems to remain relatively exceptional. A majority of endoscopists were not aware of this possibility, while others were not aware of recent technical developments that facilitate CO2 implementation in an endoscopy suite.
Lee, Sun-Young; Tang, Shou-jiang; Rockey, Don C; Weinstein, Douglas; Lara, Luis; Sreenarasimhaiah, Jayaprakash; Choi, Kyoo Wan
Anticoagulation and antiplatelet medications may potentiate GI bleeding, and their use may lead to an increased need for a GI endoscopy. We hypothesized that there might be different practice patterns among international endoscopists. To explore the differences in management practices for patients who receive anticoagulation and antiplatelet medications from Eastern and Western endoscopists. International survey study. Academic medical centers and private clinics. Members of the American Society for Gastrointestinal Endoscopy (ASGE) in Eastern (Korea, Japan, China, India, Thailand, Singapore, Malaysia, and Philippines) and Western (United States and Canada) countries were invited to complete a Web-site-based questionnaire. In addition, the questionnaire was sent to university hospitals in South Korea and academic institutions in the United States. A survey was administered that contained detailed questions about the use of an endoscopy in patients on anticoagulation and antiplatelet medications. Different opinions and clinical practice patterns regarding the use of anticoagulation and antiplatelet medications by Eastern and Western endoscopists. A total of 105 Eastern and 106 Western endoscopists completed the survey. Western endoscopists experienced more instances of procedure-related bleeding (P = .003) and thromboembolism after withdrawal of medications (P = .016). Eastern endoscopists restarted medications later (1-3 days) than Western endoscopists after a biopsy (same day) (P education are required in the area of GI endoscopy for patients on anticoagulation and antiplatelet medications, particularly given that individual patient characteristics may be associated with unique types of complications.
Izanloo, Azra; Fathi, Mehdi; Izanloo, Sara; Vosooghinia, Hassan; Hashemian, Alireza; Sadrzadeh, Sayyed Majid; Ghaffarzadehgan, Kamran
Background: As pain and nausea is usually associated with endoscopy procedure, its management is important to alleviate patients’ anxious in this regard. Objectives: The present study aimed to examine the effectiveness of conversational hypnosis in reducing anxiety and endoscopy-related complications as well as its role in increasing the satisfaction of patients exposed to endoscopic procedures. Patients and Methods: The participants of upper GI endoscopy procedure were randomly assigned to an experiment group (with conversational hypnosis intervention, n = 93) and a control group (n = 47). The participants’ hemodynamic indexes (HR, blood pressure, pulse oximetry), anxiety, satisfaction level, and complications resulted from the procedure were monitored and included in the self-administered questionnaire. Results: The results indicated that the participants in experiment group had a significant reduction of anxiety in the posttest. The adverse side effects such as vomiting, nausea, and hiccups in the experimental group was less than the control group, though this difference was not significant (P = 0.54). Conclusions: The results suggested that conversational hypnosis technique could reduce anxiety as well as the sedation process in invasive procedures such as endoscopy. PMID:26587402
Kring, Thomas S; Piper, Thomas B; Jørgensen, Lars N
Soluble cancer-related protein biomarker levels may be increased in subjects without findings at large bowel endoscopy performed due to symptoms associated with colorectal cancer. The present study focused on a possible association between increased biomarker levels in such subjects and subsequen...
Zhi-Zheng Ge; Yun-Biao Hu; Shu-Dong Xiao
AIM: To evaluate the effectiveness of wireless capsule endoscopy in patients with suspected Crohn′s disease (CD)of the small bowel undetected by conventional modalities,and to determine the diagnostic yield of M2A Given Capsule.METHODS: From lay 2002 to April 2003, we prospectively examined 20 patients with suspected CD by capsule endoscopy. The patients had the following features:abdominal pain, weight loss, positive fecal occult blood test, iron deficiency anaemia, diarrhoea and fever. All the patients had normal results in small bowel series (SBS)and in upper and lower gastrointestinal endoscopy before they were examined. Mean duration of symptoms before diagnosis was 6.5 years.RESULTS: Of the 20 patients, 13 (65%) were diagnosed as CD of the small bowel according to the findings of M2A Given Capsule. The findings detected by the capsule were mucosal erosions (2 patients), aphthas (5 patients),nodularity (1 patient), large ulcers (2 patients), and ulcerated stenosis (3 patients). The distribution of the lesions was mainly in the distal part of the small bowel,and the mild degree of lesions was 54%.CONCLUSION: Wireless capsule endoscopy is effective in diagnosing patients with suspected CD undetected by conventional diagnostic methods. It can be used to detect early lesions in the small bowel of patients with CD.
Trap, R; Skarbye, M; Rosenberg, J
INTRODUCTION: Preliminary studies have suggested a beneficial effect of second look endoscopy in patients with bleeding peptic ulcers. METHODOLOGY: We have performed a retrospective survey of seventy patients with bleeding peptic ulcers admitted to our unit in the period 1 September 1996-31 March...
López-Picazo, Julio; Alberca de Las Parras, Fernando; Sánchez Del Río, Antonio; Pérez Romero, Shirley; León Molina, Joaquín; Júdez, Francisco Javier
The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.
Sauer, Bryan G; Singh, Kanwar P; Wagner, Barry L; Vanden Hoek, Matthew S; Twilley, Katherine; Cohn, Steven M; Shami, Vanessa M; Wang, Andrew Y
Background and study aims: The projected increased demand for health services obligates healthcare organizations to operate efficiently. Discrete event simulation (DES) is a modeling method that allows for optimization of systems through virtual testing of different configurations before implementation. The objective of this study was to identify strategies to improve the daily efficiencies of an endoscopy center with the use of DES. Methods: We built a DES model of a five procedure room endoscopy unit at a tertiary-care university medical center. After validating the baseline model, we tested alternate configurations to run the endoscopy suite and evaluated outcomes associated with each change. The main outcome measures included adequate number of preparation and recovery rooms, blocked inflow, delay times, blocked outflows, and patient cycle time. Results: Based on a sensitivity analysis, the adequate number of preparation rooms is eight and recovery rooms is nine for a five procedure room unit (total 3.4 preparation and recovery rooms per procedure room). Simple changes to procedure scheduling and patient arrival times led to a modest improvement in efficiency. Increasing the preparation/recovery rooms based on the sensitivity analysis led to significant improvements in efficiency. Conclusions: By applying tools such as DES, we can model changes in an environment with complex interactions and find ways to improve the medical care we provide. DES is applicable to any endoscopy unit and would be particularly valuable to those who are trying to improve on the efficiency of care and patient experience.
Egea Valenzuela, Juan; Carrilero Zaragoza, Gabriel; Iglesias Jorquera, Elena; Tomás Pujante, Paula; Alberca de Las Parras, Fernando; Carballo Álvarez, Fernando
Capsule endoscopy was approved by the FDA in 2001. Gastrointestinal bleeding and inflammatory bowel disease are the main indications. It has been available in our hospital since 2004. We retrospectively analysed data from patients who underwent small bowel capsule endoscopy in our hospital from October 2004 to April 2015. Indications were divided into: Obscure gastrointestinal bleeding (occult and overt), inflammatory bowel disease, and other indications. Findings were divided into: Vascular lesions, inflammatory lesions, other lesions, normal studies, and inconclusive studies. A total of 1027 out of 1291 small bowel studies were included. Mean patient age was 56.45 years; 471 were men and 556 women. The most common lesion observed was angiectasia, as an isolated finding or associated with other lesions. Findings were significant in up to 80% of studies when the indication was gastrointestinal bleeding, but in only 50% of studies in inflammatory bowel disease. Diagnostic yield was low in the group «other indications». No major complications were reported. Small bowel capsule endoscopy has high diagnostic yield in patients with gastrointestinal bleeding, but yield is lower in patients with inflammatory bowel disease. Our experience shows that capsule endoscopy is a safe and useful tool for the diagnosis of small bowel disease. The diagnostic yield of the technique in inflammatory bowel disease must be improved. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.
Full Text Available Objective The present study summarizes the treatment of biliary complications after bilioenteric anastomosis via jejunal loop endoscopy.Methods The clinical data of nine cases(12 times of biliary complications after bilioenteric anastomosis were retrospectively analyzed.The patients were admitted to the Endoscopy Department of the General Hospital of the Shenyang Military Area from December 2005 to July 2011 and were treated via jejunal loop endoscopy.Results The success probability of the operation was 100%(12/12,and the incidence rate of anastomotic stenosis during operation was 88.9%(8/9.Seven cases experienced alleviation or no recurrence of reflux cholangitis after the operation.Bilirubin decreased significantly in six cases,and the stone clearance rate was 100%(3/3.Biliary metal stents were implanted in two cases,plastic stents were employed in five,and naso-biliary tubes were used in the other two.After operation,intestinal fistula occurred in one case,liver abscess occurred in another,and incision infection occurred in three other cases.Conclusion Jejunal loop endoscopy is a highly effective and minimally invasive treatment for biliary complications after bilioenteric anastomosis and,thus,should be widely applied in clinical practice.
Harewood, Gavin C
With increasing volumes of endoscopic procedures, endoscopists\\' workload has had to increase to meet this escalating demand. The aim of this study was to characterize the impact of endoscopist fatigue on quality of endoscopy performance by comparing outcomes based on chronological procedure order.
J. L. Matas
Full Text Available Introduction: the capsule endoscopy (CE, from his approval, has become a first line diagnostic procedure for the study of the small bowel disease. The aim of this study is to report our experience since the implantation of this technique in our hospital. Material and methods: retrospective review of the CE undertaken in Department of Endoscopy. There was gathered in every case the age, sex, motive of consultation, previous diagnostic procedures, capsule endoscopy findings and complication of the technique. One took to end a descriptive and analytical analysis. Results: there was achieved a total of 416 explorations in 388 patients. The obscure gastrointestinal bleeding was the most frequent indication (83.30% followed by suspected Crohn's disease (7.5%. Angiodisplasia was the endoscopic lesion more frequently detected (42.2%, especially, in patients with digestive bleeding of obscure origin (OR 3.13 p Introducción: la cápsula endoscópica desde su aprobación se ha convertido en un procedimiento diagnóstico de primera línea para el estudio del intestino delgado. El objetivo del estudio es exponer la experiencia desde la implantación de esta técnica en nuestro hospital. Material y métodos: se hizo una revisión retrospectiva de los estudios realizados en el Servicio de Endoscopia. Se recogió en cada caso la edad, sexo, motivo de consulta, procedimientos diagnósticos previos, diagnósticos endoscópicos e incidencias inherentes a la técnica y se llevó a cabo un análisis descriptivo y analítico. Resultados: se realizaron un total de 416 exploraciones en 388 pacientes. La hemorragia digestiva de origen oscuro fue la indicación más frecuente (83,30% seguida de la sospecha de enfermedad de Crohn (7,5%. La angiodisplasia fue la lesión endoscópica más detectada (42,2% cuando se analizó la hemorragia digestiva oscura (OR 3.13 p < 0,001 seguida de la flebectasia (10,6% y las úlceras sugerentes de enfermedad de Crohn (9,9%. La
Construccion y validacion del Cuestionario de Experiencias de Violencia en las Relaciones de Pareja y Familia en Estudiantes Universitarios.(Cuestionario de Experiencias de Violencia en las Relaciones de Pareja y Familia en Estudiantes Universitarios)
Vazquez Ramos, Robinson A; Jimenez Chafey, Maria I; De Jesus Carrasquillo, Damaris; Villafane Santiago, Angel A
Este estudio presenta el proceso de desarrollo del Cuestionario de Experiencias de Violencia en las Relaciones de Pareja y Familia en Estudiantes Universitarios, asi como sus propiedades psicometricas...
Banc-Husu, Anna M; Ahmad, Nuzhat A; Chandrasekhara, Vinay; Ginsberg, Gregory G; Jaffe, David L; Kochman, Michael L; Rajala, Michael W; Mamula, Petar
Gastrointestinal bleeding is one of the most common indications for urgent endoscopy in the pediatric setting. The majority of these procedures are performed for control of variceal bleeding, with few performed for nonvariceal upper gastrointestinal (NVUGI) bleeding. The data on therapeutic endoscopy for NVUGI are sparse. The aims of our study were to review our experience with NVUGI bleeding, describe technical aspects and outcomes of therapeutic endoscopy, and determine gastroenterology fellows' training opportunities according to the national training guidelines. We performed a retrospective review of endoscopy database (Endoworks, Olympus Inc, Center Valley, PA) from January 2009 to December 2014. The search used the following keywords: bleeding, hematemesis, melena, injection, epinephrine, cautery, clip, and argon plasma coagulation. The collected data included demographics, description of bleeding lesion and medical/endoscopic therapy, rate of rebleeding, relevant laboratories, physical examination, and need for transfusion and surgery. The study was approved by the institutional review board. During the study period 12,737 upper endoscopies (esophagogastroduodenoscopies) were performed. A total of 15 patients underwent 17 esophagogastroduodenoscopies that required therapeutic intervention to control bleeding (1:750 procedures). The mean ± standard deviation (median) age of patients who required endoscopic intervention was 11.6 ± 6.0 years (14.0 years). Seven out of 17 patients received dual therapy to control the bleeding lesions. All but 3 patients received medical therapy with intravenous proton pump inhibitor, and 3 received octreotide infusions. Six of the patients experienced rebleeding (40%), with 4 out of 6 initially only receiving single modality therapy. Two of these patients eventually required surgical intervention to control bleeding and both patients presented with bleeding duodenal ulcers. There were no cases of aspiration