Gastric emptying evaluation by ultrasound prior colonoscopy:An easy tool following bowel preparation

AIM: To investigate the gastric emptying after bowel preparation to allow general anaesthesia.

Helpfulness of the combination of acetic acid and FICE in the detection of Barrett's epithelium and Barrett's associated neoplasias

AIM:To investigate the mucosal morphology in Barrett's oesophagus by chromo and magnifying endoscopy.METHODS:A prospective pilot study at a tertiary medical centre was conducted to evaluate the use of acetic acid pulverisation combined with virtual chromoendoscopy using Fujinon intelligent chromoendoscopy(FICE) for semiological characterization of the mucosal morphology in Barrett's oesophagus and its neoplastic complications.Upper endoscopy using high definition whitelight,2% acid acetic pulverisation and FICE with high definition videoendoscopy were performed in 20 patients including 18 patients who presented with aspects of Barrett's oesophagus at endoscopy examination.Two patients used as controls had normal endoscopy and histological results.Prospectively,videos were watched blind from histological results by three trained FICE technique endoscopists.RESULTS:The videos of patients with high-grade dysplasia showed an irregular mucosal pattern in 14% using high definition white light endoscopy and in 100% using acid acetic-FICE combined.Videos did not identify irregular vascular patterns using high definition white light endoscopy,while acid acetic-FICE combined visualised one in 86% of cases.CONCLUSION:Combined acetic acid and FICE is a promising method for screening high-grade dysplasia and early cancer in Barrett's oesophagus.

Toward an easier indigocarmine chromoendoscopy

Indigocarmine chromoendoscopy has been proven to improve the detection of colonic lesions during screening colonoscopy, and is associated with increased adenoma detection rates. Furthermore, it is commonly used to help in the delineation and characterization of colorectal neoplasms. However, it usually requires the use of a spraying catheter that decreases the suction capacity of the endoscope, and is time- consuming. Herein, we report on the feasibility of indigo carmine chromoendoscopy during colonoscopy without using a spraying catheter, with the dye being administered through the air/water channel of the endoscope. Since the suction channel remains free, the air can be exsufflated and the staining then applies uniformly onto the colonic walls with the excess indigocarmine dye being immediately eliminated. In our experience with various types of colonoscopes and cap-assisted colonoscopy, this procedure makes indigocarmine chromoendoscopy much easier and quicker to perform, and might save the use of a spray catheter.

Optimization of the generator settings for endobiliary radiofrequency ablation

AIM:To determine the optimal generator settings for endobiliary radiofrequency ablation. METHODS:Endobiliary radiofrequency ablation was performed in live swine on the ampulla of Vater,the common bile duct and in the hepatic parenchyma. Radiofrequency ablation time,"effect",and power were allowed to vary. The animals were sacrificed two hours after the procedure. Histopathological assessment of the depth of the thermal lesions was performed. RESULTS:Twenty-five radiofrequency bursts were applied in three swine. In the ampulla of Vater(n = 3),necrosis of the duodenal wall was observed starting with an effect set at 8,power output set at 10 W,and a 30 s shot duration,whereas superficial mucosal damage of up to 350 μm in depth was recorded for an effect set at 8,power output set at 6 W and a 30 s shot duration. In the common bile duct(n = 4),a 1070 μm,safe and efficient ablation was obtained for an effect set at 8,a power output of 8 W,and an ablation time of 30 s. Within the hepatic parenchyma(n = 18),the depth of tissue damage varied from 1620 μm(effect = 8,power = 10 W,ablation time = 15 s) to 4480 μm(effect = 8,power = 8 W,ablation time = 90 s). CONCLUSION:The duration of the catheter application appeared to be the most important parameter influencing the depth of the thermal injury during endobiliary radiofrequency ablation. In healthy swine,the currently recommended settings of the generator may induce severe,supratherapeutic tissue damage in the biliary tree,especially in the high-risk area of the ampulla of Vater.