EP.WE.718An audit of the photographic documentation of upper gastrointestinal endoscopy at Cork University Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Stephen O'Brien ◽  
Niamh Foley ◽  
Amy Edwards Murphy ◽  
Morgan McCourt ◽  
Shane Killeen ◽  
...  
Keyword(s):  
Performance Indicator ◽  
Duodenal Bulb ◽  
University Hospital ◽  
British Society ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Anatomical Landmarks ◽  
Technical Failure ◽  
Photographic Documentation ◽  
Upper Gastrointestinal

Abstract Introduction A joint statement by the British Society of Gastroenterology and the Association of Upper Gastrointestinal Surgeons in 2017 recommended that photographic documentation of relevant anatomical landmarks should be a Key Performance Indicator of oesophagogastroduodenoscopy (OGD). The aim of this study was to assess this photodocumentation standard among surgeons and gastroenterologists in a tertiary referral centre. Methods Cork University Hospital endoscopy unit records were examined for a 2-month period from 01/10/20-27/11/20. OGDs were performed by 3 consultant colorectal surgeons and 4 consultant gastroenterologists over the time period. Demographic data and photodoumentation information were obtained from the Endoraad GI reporting tool. Surgeons and gastroenterologists performances was compared using the chi-squared test. Results 104 OGDs were analysed. Fifty-three (51%) OGDs were performed in women and 51(49%) OGDs were performed by surgeons. The documentation for each site was; gastro-oesophageal junction- 68% (69/102), fundus on retroflexion- 71% (72/102), gastric body- 32% (33/102), antrum- 61% (62/102), and duodenal bulb- 35% (36/102), without significant differences (p > 0.05) for these sites between surgeons and gastroenterologists. There was more documentation of the upper oesophagus by surgeons (31% vs.12%, p = 0.030) and there was more documentation of the distal duodenum by gastroenterologists (90% vs.47%, p < 0.01). Pictures were unable to be saved in two patients due to technical failure. Discussion Photodocumentation is increasingly important from a medico-legal viewpoint. There is room for improvement in our centre, but these rates are comparable to other published series. An educational session is being planned and following this adherence to photodocumentation standards will be re-examined.

scholarly journals Composite detection rate as an upper gastrointestinal endoscopy quality measure correlating with detection of neoplasia

2021 ◽  
Author(s):  
Marcin Romańczyk ◽  
Bartosz Ostrowski ◽  
Tomasz Marek ◽  
Tomasz Romańczyk ◽  
Małgorzata Błaszczyńska ◽  
...  
Keyword(s):  
Detection Rate ◽  
Duodenal Bulb ◽  
General Setting ◽  
Quality Measure ◽  
University Hospital ◽  
Gastrointestinal Neoplasms ◽  
Upper Gastrointestinal Endoscopy ◽  
Group 4 ◽  
Upper Gastrointestinal ◽  
Group 1

Abstract Background Esophagogastroduodenoscopy (EGD) is commonly used diagnostic method with no widely accepted quality measure. We assessed quality indicator—composite detection rate (CDR)—consisting of detection of at least one of the following: cervical inlet patch, gastric polyp and post-ulcer duodenal bulb deformation. The aim of the study was to validate CDR according to detection rate of upper gastrointestinal neoplasms (UGN). Methods It was a multicenter, prospective, observational study conducted from January 2019 to October 2019. The endoscopic reports from 2896 symptomatic patients who underwent diagnostic EGD were analyzed. The EGDs were performed in three endoscopy units located in tertiary university hospital, private outpatient clinic and local hospital. Results 64 UGNs were detected. The mean CDR was 21.9%. The CDR correlated with UGN detection rate (R = 0.49, p = 0.045). Based on CDR quartiles, operators were divided into group 1 with CDR < 10%, group 2 with CDR 10–17%, group 3 with CDR 17.1–26%, and group 4 with CDR > 26%. Detection rate of UGN was significantly higher in the group 4 in comparison to group 1 (OR 4.4; 95% CI 2.2 − 9.0). In the multivariate regression model, patient age, male gender and operator’s CDR > 26% were independent risk factors of UGN detection (OR 1.03; 95% CI 1.01 − 1.05, OR 2; 95% CI 1.2 − 3.5, and OR 5.7 95% CI 1.5 − 22.3, respectively). Conclusions The CDR is associated with the detection of upper gastrointestinal neoplasms. This parameter may be a useful quality measure of EGD to be applied in general setting.

scholarly journals AB166. SOH21AS166. An audit of the photographic documentation of upper gastrointestinal endoscopy at Cork University Hospital

2021 ◽  
Vol 5 ◽  
pp. AB166-AB166
Author(s):  
Stephen John O’Brien ◽  
Niamh Foley ◽  
Amy Edwards Murphy ◽  
Morgan McCourt ◽  
Shane Killeen ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
University Hospital ◽  
Upper Gastrointestinal Endoscopy ◽  
Photographic Documentation ◽  
Upper Gastrointestinal

scholarly journals Protein losing gastroenteropathy due to Helicobacter pylori infection without giant rugal folds, erosion or polyposis

2019 ◽  
Vol 12 (11) ◽  
pp. e230870
Author(s):  
Katsunobu Yoshioka ◽  
Masanori Kishibuchi ◽  
Ko Takada
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Clinical Symptoms ◽  
Duodenal Bulb ◽  
Human Albumin ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Endoscopic Findings ◽  
Urease Test ◽  
H Pylori ◽  
Upper Gastrointestinal

An 85-year-old woman was admitted to our hospital because of progressive hypoproteinemia and generalised oedema. Technetium-99m human albumin scintigraphy revealed protein leakage in the gastrointestinal tract. Upper gastrointestinal endoscopy revealed small whitish nodules from the gastric body up to the duodenal bulb. The urease test for Helicobacter pylori infection was positive. We diagnosed her as having protein-losing gastroenteropathy (PLGE) caused by H. pylori infection. The patient’s hypoproteinemia and clinical symptoms promptly resolved after H. pylori eradication. Our results suggest that a trial of H. pylori eradication is warranted in patients with PLGE, even if endoscopy reveals neither giant rugal folds, erosion of the mucosa, nor polyposis, which are previously reported characteristic endoscopic findings of PLGE.

scholarly journals Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy

2021 ◽  
Vol 12 (01) ◽  
pp. 011-018
Author(s):  
Shrihari Anil Anikhindi ◽  
Ashish Kumar ◽  
Noriya Uedo ◽  
Vikas Singla ◽  
Akshay Anikhindi ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Duodenal Bulb ◽  
Gastric Fundus ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Optimal Outcomes ◽  
The Mean ◽  
The Difference ◽  
Upper Gastrointestinal ◽  
Control Study

Abstract Introduction With the advancements in diagnostic and therapeutic upper gastrointestinal endoscopy (UGIE), clear mucosal visualization is essential to ensure optimal outcomes. Though routinely followed in Japan and Korea, pre-endoscopic preparation is seldom used in India. We evaluated the efficacy of a pre-endoscopic drink of N-acetylcysteine (NAC) and simethicone in improving mucosal visibility during UGIE. Patients and Methods This study was a retrospective, investigator blind study with a case–control study design. Cases included patients who received a pre-endoscopy drink of NAC and simethicone in 100 mL water administered 10 to 30 minutes prior to UGIE. Controls only had mandatory fasting for 6 to 8 hours prior to UGIE. Propensity score matching was done to ensure comparability between the groups. Digital images were taken at six standard landmarks during UGIE and stored. A blinded investigator subsequently analyzed the images and rated the mucosal visibility on a 3-point scale. The difference in the mean mucosal visibility between the cases and controls was compared. Results Mean mucosal visibility during UGIE was significantly better using NAC with simethicone as compared with no preparation at esophagus (1.14 [0.37] vs. 1.47 [0.62], p < 0.05), gastric fundus (1.10 [0.30] vs. 1.55 [0.64], p < 0.05), gastric body (1.22 [0.50] vs. 1.62 [0.73], p < 0.05), gastric antrum (1.13 [0.37] vs. 1.47 [0.62], p < 0.05), and duodenal bulb (1.13 [0.34] vs. 1.33 [0.56], p < 0.05). In distal duodenum, though visibility improved with NAC with simethicone, the difference was insignificant. There were no adverse events related to the pre-endoscopy drink. Conclusion A pre-endoscopy drink of NAC with simethicone can significantly improve mucosal visibility during UGIE. It is safe, cheap, easily available and maybe considered for routine utilization for ensuring optimal endoscopic outcomes.

Duodenal Bulb Adenocarcinoma Benefitted from Neoadjuvant Chemotherapy: A Case Report

Chemotherapy ◽  
2017 ◽  
Vol 62 (5) ◽  
pp. 290-294 ◽  
Author(s):  
Geng-Yuan Zhang ◽  
Jie Mao ◽  
Bin Zhao ◽  
Bo Long ◽  
Hao Zhan ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Comprehensive Evaluation ◽  
Duodenal Bulb ◽  
Treatment Modalities ◽  
Pathological Examination ◽  
Upper Gastrointestinal Endoscopy ◽  
Tumor Type ◽  
Low Incidence ◽  
Rare Malignancy ◽  
Upper Gastrointestinal

Duodenal bulb adenocarcinoma is an extremely rare malignancy in the alimentary tract which has a low incidence rate and nonspecific symptoms. It is difficult to diagnose early, and the misdiagnosis rate is high. CT, MRI, upper gastrointestinal endoscopy, and other advanced imaging modalities should be combined to make a comprehensive evaluation. The diagnostic confirmation of this tumor type mainly depends on the pathological examination. The combination of surgery with other treatment modalities is effective. A review of reports on duodenal bulb adenocarcinoma with chemotherapy revealed 6 cases since 1990. However, there are few reports on neoadjuvant chemotherapy for the disease. In this report, preoperative S-1 in combination with oxaliplatin neoadjuvant chemotherapy achieved a complete pathological response in the treatment of duodenal bulb adenocarcinoma. Neoadjuvant chemotherapy shows a better clinical efficacy in the treatment of duodenal bulb adenocarcinoma, but its value needs to be further verified.

scholarly journals Prevalence of dual clarithromycin and metronidazole resistance in Helicobacter pylori estimated by molecular methods in Santiago, Chile

2017 ◽  
Author(s):  
Patricio Gonzalez-Hormazabal ◽  
Maher Musleh ◽  
Susana Escandar ◽  
Hector Valladares ◽  
Enrique Lanzarini ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastric Mucosa ◽  
Initial Approximation ◽  
Molecular Methods ◽  
University Hospital ◽  
Upper Gastrointestinal Endoscopy ◽  
Metronidazole Resistance ◽  
Two Samples ◽  
H Pylori ◽  
Upper Gastrointestinal

AbstractBackgroundCurrent available treatments for Helicobacter pylori eradication are chosen according to local clarithromycin and metronidazole resistance prevalence. The aim of this study was to estimate, by means of molecular methods, both clarithromycin and metronidazole resistance in gastric mucosa from patients infected with H.pylori.MethodsA total of 191 DNA samples were analyzed. DNA was purified from gastric mucosa obtained from patients who underwent an upper gastrointestinal endoscopy at an university hospital from Santiago, Chile, between 2011 and 2014. H.pylori was detected by real-time PCR. A 5’exonuclease assay was developed to detect A2142G and A2143G mutations among Hpylori-positive samples. rdxA gene was sequenced in samples harboring A2142G and A2143G mutations in order to detect mutations that potentially confer dual clarithromycin and metronidazole resistance.ResultsNinety-three (93) out of 191 DNA samples obtained from gastric mucosa were H. pylori-positive (48.7%). Clarithromycin-resistance was detected in 29 samples (31.2% [95%CI 22.0%-41.6%]). The sequencing of rdxA gene revealed that two samples harbored truncating mutations in rdxA, one sample had an in-frame deletion, and 11 had amino acid changes that likely cause metronidazole resistance.ConclusionsWe estimated a prevalence of clarithomycin-resistance of 31.8% in Santiago, Chile. The proportion of dual clarithromycin and metronidazole resistance could be, at least, 15.0%. Our results require further confirmation. Nevertheless, they are significant as an initial approximation in re-evaluating the guidelines for H.pylori eradication currently used in Chile.

scholarly journals Ligation assisted endoscopic mucosal resection of neuroendocrine tumor of duodenal bulb: a case report with a follow up of 24 months

2019 ◽  
Vol 8 (1) ◽  
pp. 18-20
Author(s):  
Umid Kumar Shestha ◽  
Gopi Aryal
Keyword(s):  
Neuroendocrine Tumor ◽  
Distant Metastasis ◽  
Gastrointestinal Endoscopy ◽  
Duodenal Bulb ◽  
Upper Gastrointestinal Endoscopy ◽  
Solitary Lesion ◽  
Free Margin ◽  
Mucosal Resection ◽  
Upper Gastrointestinal

Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy. Eendoscopic Mucosal Resection (EMR) has been the commonly used endoscopic procedure for duodenal carcinoid tumors, but the conventional EMR done to resect duodenal NET s is likely to have positive vertical margins. However, the ligation assisted EMR has recently been shown to be a promising technique for the treatment of duodenal NET that can have a negative free margin. In our study, we present a patient of 51-year-old male, who presented with pain over epigastrium and upper gastrointestinal endoscopy revealed a small submucosal lesion of 10 mm in the duodenal bulb. The endoscopic ultrasound showed the lesion arising from the echo layer three. The biopsy was taken which showed the duodenal NET. The computed tomography of abdomen did not show any evidence of distant metastasis. The EMR of duodenal NET was done by band ligation technique. The biopsy from the resected duodenal lesion confirmed the duodenal NET with the margin free of the tumor. The patient was followed at 6, 12, 18 and 24 months. During the follow up visits, the repeat upper gastrointestinal endoscopy did not show recurrence of the lesion and there was no any evidence of distant metastasis either. Ligation assisted EMR is an acceptable treatment in the hands of expert for small duodenal NET without the evidence of metastasis and can ensure the complete removal of the lesion with vertical free margin.

scholarly journals Gastric metaplasia of the duodenal mucosa in Crohn’s disease: novel histological and endoscopic findings

2021 ◽  
Vol 09 (02) ◽  
pp. E181-E189
Author(s):  
Go Ikezono ◽  
Kenshi Yao ◽  
Kentaro Imamura ◽  
Takao Kanemitsu ◽  
Masaki Miyaoka ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Gastrointestinal Endoscopy ◽  
Duodenal Mucosa ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Endoscopic Findings ◽  
Gastric Metaplasia ◽  
Mucosal Lesions ◽  
Upper Gastrointestinal

Abstract Background and study aims Upper gastrointestinal endoscopy and biopsy are useful for differential diagnosis of Crohn’s disease (CD) of the large intestine and ulcerative colitis (UC). We aimed to identify novel histopathological and endoscopic findings in the upper gastrointestinal tract in patients with CD who did not have Helicobacter pylori infection. Patients and methods Upper gastrointestinal endoscopy was performed on patients with CD and UC. Mucosal lesions detected were subsequently observed using magnifying endoscopy with narrow-band imaging (M-NBI), following which biopsy was performed. When no mucosal lesion was detected on conventional endoscopy, M-NBI and biopsy were performed on four sites: the gastric body, gastric antrum, duodenal bulb, and second portion of the duodenum. Results The prevalences of gastric metaplasia (GM) were 48 % (24/50) and 16 % (8/50) in the CD and UC groups, showing a significant difference (P = 0.001). In 23 of 24 patients with histologically proven GM in the CD group, mucosal lesions were detected using conventional white-light imaging (C-WLI). In 22 of 24 patients with histologically proven GM in the CD group, disappearance of normal villous structure and the presence of curved marginal crypt epithelium were noted using magnifying endoscopic findings characteristic of GM (M-GM). A combination of C-WLI and M-NBI yielded a significantly increased specificity (P = 0.004) and accuracy (P = 0.039). Conclusions The prevalence of GM in the duodenal mucosa was significantly higher in patients with CD than in controls. The identified endoscopic findings may be useful as novel indicators for the histological diagnosis of GM in the duodenum.

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