Comparison of a novel bedside portable endoscopy device with nasogastric aspiration for identifying upper gastrointestinal bleeding

AIM: To compare outcomes using the novel portable endoscopy with that of nasogastric(NG) aspiration in patients with gastrointestinal bleeding.METHODS: 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.RESULTS: In total, 129 patients who had GI bleedingsigns 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.CONCLUSION: 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.

Medially based de-epithelialized flap for nasal base narrowing and nostril sill augmentation in a cleft lip nasal deformity

Aim:The authors observed the nostril floor in a gross cadaver specimen histologically and innovated a medially based de-epithelialized flap for nasal base narrowing and nostril sill augmentation.Methods:In cadaver,fully thick section was taken from the nostril sill at the midpoint of the columella base and ala base,and stained with Masson-Trichrome.In eight patients,circumferential incision along the nostril sill and alar base freed the alar base from the upper lip.At the columellar base,fresh epithelium was shaved on the medial side of the incision line.The widened scar on the upper lip was excised.The de-epithelialized tip of the columellar base was pulled under the medial tip of the alar base flap and sutured tightly.Four anthropometric distances were measured preoperatively and postoperatively.Results:Histologically the nostril sill was composed of thickened dermis.Just below the dermis,the depressor septi nasi muscle ran obliquely,augmenting the nostril sill.The nostril floor width,alar distance,and alar curvature distance decreased on the cleft side after the operation.Conclusion:A medially based de-epithelialized flap narrows the alar base and augments the nostril sill simultaneously,since the de-epithelialized part of the excess skin augments the depressed nostril sill.