Endoscopic resection using an over-the-scope clip for duodenal neuroendocrine tumors

Background and study aims Endoscopic resection of duodenal neuroendocrine tumors (DNETs) remains controversial, and its indications are still unclear. This study aimed to evaluate short-term outcomes of a newly developed endoscopic muscularis resection (EMR) method that utilizes an over-the-scope clip (OTSC), termed EMRO, for treating DNETs. Patients and methods In total, 13 consecutive patients with 14 small (≤ 10 mm) DNETs who underwent EMRO from September 2017 to March 2020 were retrospectively enrolled. EMRO was performed by a single experienced endoscopist. Patients’ characteristics and treatment outcomes were assessed. Results The En bloc and R0 resection rates were 100 % (14/14) and 92.9 % (13/14), respectively. The median pathological resected specimen size was 10 mm, with a median pathological resected tumor size of 6 mm. During the EMRO procedure, there was no occurrence of misplacement of the OTSC to the target lesion. With respect to the pathological resection depth, nine cases (64.3 %) and five cases (35.7 %) were categorized as deep submucosal resection and muscularis resection, respectively, whereas no case was categorized as full-thickness resection. There were no intraoperative or delayed perforations. However, delayed bleeding occurred in two cases. At a median follow-up of 12 months (range 7–36) after EMRO, there was no incidence of local recurrence. At the first follow-up endoscopy performed at 6 months after EMRO, the OTSC was retained in place in two of 14 DNETs (14.3 %). Conclusions EMRO can be performed safely, by an experienced endoscopist, for small (≤ 10 mm) DNETs.

Accidental Ingestion of a Plastic Water Bottle Cap

A 78-year-old male was turned up to the emergency room with a 5-day history of vomiting, diffuse abdominal pain, and altered bowel habits. After physical examination, routine blood tests, chest, and abdominal radiographs, as well as an abdominal ultrasound had been contacted to examine his ongoing symptoms, a serious intestinal obstruction was revealed. Bowel obstruction is interrelated with his medical history, as he suffered from inoperable prostate cancer. A CT scan was performed to exclude an associated complication. A plastic, 3cm diameter, water bottle cap was in the ileum revealed with no evidence of perforation or collection. A colonoscopy by an experienced endoscopist failed to reach and retrieve the plastic water bottle cap. Finally, the plastic water bottle cap was removed through an enterotomy. Even if a careful history taking can give a clue for diagnosis, the cause of bowel obstruction could be a surprise.

Sedation Free Colonoscopy: Patients’ Characteristics and satisfaction in a hospital based Endoscopy Unit

Background and aims: Colonoscopy without sedation costs less and is more convenient than sedated colonoscopy and is the main mode of examination in our settings. The aims of the present study is to determine the percentage of patients who can successfully undergo unsedated colonoscopy and the factors contributing to patient satisfaction following the examination.Material and Methods: Demographic, clinical, and colonoscopy related data were prospectively evaluated in 113 patients undergoing unsedated colonoscopy by an experienced endoscopist during the period of October 2015 to January 2016 at a single hospital based endoscopy setup. All colonoscopies routinely began without sedation and was curtailed if the patient or physician desired. Age, sex, prior abdominal operation, pain during examination and the time required to complete the colonoscopy were recorded. The patients were asked to rate their pain on scale of 0 to 10, their satisfaction and willingness to undergo colonoscopy without sedation in future if required.Results: In a total of 113 patients (mean age of 54.01 years) undergoing sedation free colonoscopy, 108 (95.5%) required no sedation. Complete colonoscopy was done in 106 of the 108 and 110 of the 113 patients. The mean pain score was 2.58 in an average time taken of 11.9 minutes. Average time for intubation taken in post-operative patients (n=20) was 12.24 minutes. 96(84.9%) of the patients were completely or well satisfied with the examination and 7(6.2%) were not satisfied with the procedure. There was not much difference in pain perception or satisfaction based on gender.Conclusion: Colonoscopy without sedation can be completed successfully in a vast majority of patients with proper technique by experienced endoscopist. The practice saves time and money and patients are willing to return for future examinations if required. The facility of sedation should be present if required for any reason.

Application of Color Television in Bronchoesophagology

The educational value of utilizing modern color television studio equipment for endoscopic examinations has improved the efficiency with which the experienced endoscopist can train other physicians. Experience with a color television-endoscopy program has demonstrated the following additional advantages: 1) unlimited audience during real-time viewing; 2) efficient training of endoscopic personnel; 3) endoscopic image magnification; 4) videotape recording; 5) immediate playback; 6) Polaroid photographs of endoscopic lesions from TV monitor for patient's record; 7) patient education; and 8) videotape editing for educational purposes. The basic requirements for a comprehensive color television-endoscopy program including personnel, light sources, endoscopes, cameras, test equipment, synchronization, picture monitors, and videotape recorders are briefly described. This description is related to assist other physicians and associated personnel who wish to implement their own television-endoscopy program.