Background: EMR with circumferential mucosal incision facilitates en bloc resection, which is the most important predictor for complete resection in the treatment of intramucosal gastric neoplasm. The objective of the...Background: EMR with circumferential mucosal incision facilitates en bloc resection, which is the most important predictor for complete resection in the treatment of intramucosal gastric neoplasm. The objective of the study was to evaluate the efficacy and the safety of EMR with circumferential mucosal incision in re lation to the endoscopist‘s experience. Methods: In this retrospective study, w e analyzed the outcome of 80 EMR procedures performed by a single endoscopist at the National Cancer Center, Goyang, Korea. The EMR procedure with circumferenti al mucosal incision was performed with a conventional needle knife. We compared the en bloc resection rate, the complete resection rate, the duration of the pro cedure time, and the associated complications by quartiles. Results: From the fi rst to the last quartile, en bloc resection rates were 55%, 45%, 85%, and 85 %(p = 0.006), and complete resection rates were 65%, 60%, 90%, and 85%(p = 0.039) . The increase in the mean en bloc and complete resection rates between t he first two quartiles and the second two quartiles was significant (p = 0.002 a nd p = 0.019, respectively). Three perforations (15%) were reported in the firs t qua rtile and only one (1.7%) in the remaining 3 quartiles (p = 0.046) . The proced ure time also decreased after the first 20 cases (p = 0.004). Conclusions: For a n experienced endoscopist, EMR with circumferential mucosal incision could be pe rformed effectively and safely after the experience of 40 cases.展开更多
Background Catheter/guidewire exchanges during ERCP require the coordinated ef forts of an endoscopist and endoscopy assistant. Aprototype duodenoscopewas deve loped to improve the control of catheter/guidewire exchan...Background Catheter/guidewire exchanges during ERCP require the coordinated ef forts of an endoscopist and endoscopy assistant. Aprototype duodenoscopewas deve loped to improve the control of catheter/guidewire exchange by enabling fixation of guidewires at the elevator lever. MethodsAn initial prototype duodenoscope a nd a subsequent modification of this instrument were used to perform ERCP in 7 a nd 10 patients, respectively.The following were recorded: total procedure time, fluoroscopy time, catheter/guidewire exchange time, guidewire repositioning,loss of guidewire access, success or failure of fixation,and endoscopist satisfactio n. Observations The initial and the modified prototype duodenoscopes were used i n a variety of catheter/guidewire exchanges (n=46). Guidewire fixation was achie ved in 75%of catheter/guidewire exchanges with the initial prototype and in 93 %with the modified prototype and was reflected in shorter exchange times. Acces s to the desired duct was not lost during any exchange, and the need for reposit ioning was eliminated. Conclusions A new prototype duodenoscope with an elevator lever that enables guidewire fixation will improve the ease and efficiency of c atheter/guidewire exchange during ERCP. Modifications made to the original proto type improved reliability of guidewire fixation.展开更多
AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questi...AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy.They were asked about the reasons for their preference,choice of orifice,and extent of complication risk they were willing to accept.RESULTS:Fifty patients(50%)and only 21 physicians(21%)preferred NOTES(P<0.001).Patients had previously heard of NOTES less frequently(7%vs73%,P<0.001)and had undergone endoscopy more frequently(88%vs 36%,P<0.001)than physicians.Absence of hernia was the most common reason for NOTES preference in physicians(80%vs 44%,P= 0.003),whereas reduced pain was the most common reason in patients(66%vs 52%).Physicians were more likely to refuse NOTES as a novel and unsure technique(P<0.001)and having an increased risk of infection(P<0.001).The preferred access site in both groups was colon followed by stomach,with vagina being rarely preferred.In multivariable modeling,those with high-school education[odds ratio(OR):2.68,95% confidence interval(CI):1.23-5.83]and prior colonoscopy(OR:2.10,95%CI:1.05-4.19)were more likely to prefer NOTES over laparoscopic appendectomy.There was a steep decline in NOTES preference with increased rate of procedural complications.Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians(P=0.02).CONCLUSION:The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.展开更多
AIM: To identify risk factors to help predict which patients are likely to fail to appear for an endoscopic procedure. METHODS: This was a retrospective, chart review, cohort study in a Canadian, tertiary care, academ...AIM: To identify risk factors to help predict which patients are likely to fail to appear for an endoscopic procedure. METHODS: This was a retrospective, chart review, cohort study in a Canadian, tertiary care, academic, hospital-based endoscopy clinic. Patients included were: those undergoing esophagogastroduodenoscopy, colonoscopy or flexible sigmoidoscopy and patients who failed to appear were compared to a control group. The main outcome measure was a multivariate analysis of factors associated with truancy from scheduled endoscopic procedures. Factors analyzed included gender, age, waiting time, type of procedure, referring physician, distance to hospital, first or subsequent endoscopic procedure or encounter with gastroenterologist, and urgency of the procedure. RESULTS: Two hundred and thirty-four patients did not show up for their scheduled appointment. Compared to a control group, factors statistically significantly associated with truancy in the multivariate analysis were: non-urgent vs urgent procedure (OR 1.62, 95% CI 1.06, 2.450), referred by a specialist vs a family doctor (OR 2.76, 95% CI 1.31, 5.52) and office-based consult prior to endoscopy vs consult and endoscopic procedure during the same appointment (OR 2.24, 95% CI 1.33, 3.78). CONCLUSION: Identifying patients who are not scheduled for same-day consult and endoscopy, those referred by a specialist, and those with non-urgent referrals may help reduce patient truancy.展开更多
Early diagnosis of and adequate therapy for premalignant lesions in patients with inflammatory bowel disease(IBD)and Barrett’s esophagus(BE)has been shown to decrease mortality.Endoscopic examination with histologic e...Early diagnosis of and adequate therapy for premalignant lesions in patients with inflammatory bowel disease(IBD)and Barrett’s esophagus(BE)has been shown to decrease mortality.Endoscopic examination with histologic evaluation of random and targeted biopsies remains the gold standard for early detection and adequate treatment of neoplasia in both these diseases.Although eventual patient management(including surveillance and treatment)depends upon a precise histologic assessment of the initial biopsy,accurately diagnosing and grading IBD-and BE-associated dysplasia is still considered challenging by many general as well as subspecialized pathologists.Additionally,there are continuing updates in the literature regarding the diagnosis,surveillance,and treatment of these disease entities.This comprehensive review discusses the cancer risk,detailed histopathological features,diagnostic challenges,and updates as well as the latest surveillance and treatment recommendations in IBD-and BE-associated dysplasia.展开更多
Background:There is little information describing the perceptions of gastroenterology fellows and attending gastroenterologists of what constitutes effective teaching of endoscopy.We sought to identify common themes r...Background:There is little information describing the perceptions of gastroenterology fellows and attending gastroenterologists of what constitutes effective teaching of endoscopy.We sought to identify common themes regarding endoscopy training methods and their impact among fellows and attendings.Methods:Focus group exercises and surveys were conducted among fellows,about educational resources,teaching techniques and ways of improving the teaching of endoscopy.The fellows identified the‘best’teachers of endoscopy,who were interviewed regarding their training in endoscopy,their teaching methods,key points of information,and opinions on endoscopy curriculum.Results:Nineteen fellows(68%)had attended the American Society for Gastrointestinal Endoscopy First Year Fellows’Endoscopy course and found it very helpful.Thirteen fellows(46%)had exposure to an endoscopy simulator,but their median duration of use was only 1 hour.Only two out of five fellowship programs used a formal endoscopic skill assessment tool and none of the programs had an endoscopy curriculum of which the fellows were aware.Fellows reported that they learned endoscopy best by performing procedures.They also volunteered that attending gastroenterologists used variable teaching methods,and might benefit from instruction on how to teach endoscopy.Ten attending gastroenterologists(77%)had received training in advanced procedures;none received formal training on teaching endoscopy:they all felt that such training would be beneficial.Conclusions:A standardized endoscopy curriculum may be beneficial to fellows,who prefer to learn endoscopy by performing procedures—but they want explicit and specific instruction.Both those attending and the fellows thought that formal instruction for attending gastroenterologists on how to teach endoscopy would be beneficial,indicating a role for a‘teachthe-teacher’curriculum.展开更多
In the wireless power transfer system for freely moving biomedical implants,the receiving unit was generally inefficient for the reason that its design parameters including the receiving coil's dimension and recei...In the wireless power transfer system for freely moving biomedical implants,the receiving unit was generally inefficient for the reason that its design parameters including the receiving coil's dimension and receiving circuits' topology were always determined by experiments.In order to build the relationship between these parameters and the total transfer efficiency,this paper developed a novel efficiency model based on the impedance model of the coil and the circuit model of the receiving circuits.According to the design constraints,the optimal design parameters in the worst case were derived.The results indicate that the combination of the two-layered receiving coil and half-bridge rectifier has more advantages in size,efficiency and safety,which is preferred in the receiving unit.Additionally,when the load resistance increases,the optimal turn number of the receiving coil basically keeps constant and the corresponding transmitting current and total efficiency decrease.For 100 Ω load,the transmitting current and total efficiency in the worst case were measured to be 5.30 A and 1.45% respectively,which are much better than the published results.In general,our work provides an efficient method to determine the design parameters of the wireless power transfer system for freely moving biomedical implants.展开更多
文摘Background: EMR with circumferential mucosal incision facilitates en bloc resection, which is the most important predictor for complete resection in the treatment of intramucosal gastric neoplasm. The objective of the study was to evaluate the efficacy and the safety of EMR with circumferential mucosal incision in re lation to the endoscopist‘s experience. Methods: In this retrospective study, w e analyzed the outcome of 80 EMR procedures performed by a single endoscopist at the National Cancer Center, Goyang, Korea. The EMR procedure with circumferenti al mucosal incision was performed with a conventional needle knife. We compared the en bloc resection rate, the complete resection rate, the duration of the pro cedure time, and the associated complications by quartiles. Results: From the fi rst to the last quartile, en bloc resection rates were 55%, 45%, 85%, and 85 %(p = 0.006), and complete resection rates were 65%, 60%, 90%, and 85%(p = 0.039) . The increase in the mean en bloc and complete resection rates between t he first two quartiles and the second two quartiles was significant (p = 0.002 a nd p = 0.019, respectively). Three perforations (15%) were reported in the firs t qua rtile and only one (1.7%) in the remaining 3 quartiles (p = 0.046) . The proced ure time also decreased after the first 20 cases (p = 0.004). Conclusions: For a n experienced endoscopist, EMR with circumferential mucosal incision could be pe rformed effectively and safely after the experience of 40 cases.
文摘Background Catheter/guidewire exchanges during ERCP require the coordinated ef forts of an endoscopist and endoscopy assistant. Aprototype duodenoscopewas deve loped to improve the control of catheter/guidewire exchange by enabling fixation of guidewires at the elevator lever. MethodsAn initial prototype duodenoscope a nd a subsequent modification of this instrument were used to perform ERCP in 7 a nd 10 patients, respectively.The following were recorded: total procedure time, fluoroscopy time, catheter/guidewire exchange time, guidewire repositioning,loss of guidewire access, success or failure of fixation,and endoscopist satisfactio n. Observations The initial and the modified prototype duodenoscopes were used i n a variety of catheter/guidewire exchanges (n=46). Guidewire fixation was achie ved in 75%of catheter/guidewire exchanges with the initial prototype and in 93 %with the modified prototype and was reflected in shorter exchange times. Acces s to the desired duct was not lost during any exchange, and the need for reposit ioning was eliminated. Conclusions A new prototype duodenoscope with an elevator lever that enables guidewire fixation will improve the ease and efficiency of c atheter/guidewire exchange during ERCP. Modifications made to the original proto type improved reliability of guidewire fixation.
基金Supported by Grant NT 11234-3 of the Czech Ministry of Healththe Institutional Research Plan AV0Z10300504
文摘AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy.They were asked about the reasons for their preference,choice of orifice,and extent of complication risk they were willing to accept.RESULTS:Fifty patients(50%)and only 21 physicians(21%)preferred NOTES(P<0.001).Patients had previously heard of NOTES less frequently(7%vs73%,P<0.001)and had undergone endoscopy more frequently(88%vs 36%,P<0.001)than physicians.Absence of hernia was the most common reason for NOTES preference in physicians(80%vs 44%,P= 0.003),whereas reduced pain was the most common reason in patients(66%vs 52%).Physicians were more likely to refuse NOTES as a novel and unsure technique(P<0.001)and having an increased risk of infection(P<0.001).The preferred access site in both groups was colon followed by stomach,with vagina being rarely preferred.In multivariable modeling,those with high-school education[odds ratio(OR):2.68,95% confidence interval(CI):1.23-5.83]and prior colonoscopy(OR:2.10,95%CI:1.05-4.19)were more likely to prefer NOTES over laparoscopic appendectomy.There was a steep decline in NOTES preference with increased rate of procedural complications.Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians(P=0.02).CONCLUSION:The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.
文摘AIM: To identify risk factors to help predict which patients are likely to fail to appear for an endoscopic procedure. METHODS: This was a retrospective, chart review, cohort study in a Canadian, tertiary care, academic, hospital-based endoscopy clinic. Patients included were: those undergoing esophagogastroduodenoscopy, colonoscopy or flexible sigmoidoscopy and patients who failed to appear were compared to a control group. The main outcome measure was a multivariate analysis of factors associated with truancy from scheduled endoscopic procedures. Factors analyzed included gender, age, waiting time, type of procedure, referring physician, distance to hospital, first or subsequent endoscopic procedure or encounter with gastroenterologist, and urgency of the procedure. RESULTS: Two hundred and thirty-four patients did not show up for their scheduled appointment. Compared to a control group, factors statistically significantly associated with truancy in the multivariate analysis were: non-urgent vs urgent procedure (OR 1.62, 95% CI 1.06, 2.450), referred by a specialist vs a family doctor (OR 2.76, 95% CI 1.31, 5.52) and office-based consult prior to endoscopy vs consult and endoscopic procedure during the same appointment (OR 2.24, 95% CI 1.33, 3.78). CONCLUSION: Identifying patients who are not scheduled for same-day consult and endoscopy, those referred by a specialist, and those with non-urgent referrals may help reduce patient truancy.
文摘Early diagnosis of and adequate therapy for premalignant lesions in patients with inflammatory bowel disease(IBD)and Barrett’s esophagus(BE)has been shown to decrease mortality.Endoscopic examination with histologic evaluation of random and targeted biopsies remains the gold standard for early detection and adequate treatment of neoplasia in both these diseases.Although eventual patient management(including surveillance and treatment)depends upon a precise histologic assessment of the initial biopsy,accurately diagnosing and grading IBD-and BE-associated dysplasia is still considered challenging by many general as well as subspecialized pathologists.Additionally,there are continuing updates in the literature regarding the diagnosis,surveillance,and treatment of these disease entities.This comprehensive review discusses the cancer risk,detailed histopathological features,diagnostic challenges,and updates as well as the latest surveillance and treatment recommendations in IBD-and BE-associated dysplasia.
基金Dr.Robert C.Lowe acknowledges his faculty development grant fromthe Boston University Medical Center Department of Medicine for$1,000.
文摘Background:There is little information describing the perceptions of gastroenterology fellows and attending gastroenterologists of what constitutes effective teaching of endoscopy.We sought to identify common themes regarding endoscopy training methods and their impact among fellows and attendings.Methods:Focus group exercises and surveys were conducted among fellows,about educational resources,teaching techniques and ways of improving the teaching of endoscopy.The fellows identified the‘best’teachers of endoscopy,who were interviewed regarding their training in endoscopy,their teaching methods,key points of information,and opinions on endoscopy curriculum.Results:Nineteen fellows(68%)had attended the American Society for Gastrointestinal Endoscopy First Year Fellows’Endoscopy course and found it very helpful.Thirteen fellows(46%)had exposure to an endoscopy simulator,but their median duration of use was only 1 hour.Only two out of five fellowship programs used a formal endoscopic skill assessment tool and none of the programs had an endoscopy curriculum of which the fellows were aware.Fellows reported that they learned endoscopy best by performing procedures.They also volunteered that attending gastroenterologists used variable teaching methods,and might benefit from instruction on how to teach endoscopy.Ten attending gastroenterologists(77%)had received training in advanced procedures;none received formal training on teaching endoscopy:they all felt that such training would be beneficial.Conclusions:A standardized endoscopy curriculum may be beneficial to fellows,who prefer to learn endoscopy by performing procedures—but they want explicit and specific instruction.Both those attending and the fellows thought that formal instruction for attending gastroenterologists on how to teach endoscopy would be beneficial,indicating a role for a‘teachthe-teacher’curriculum.
基金supported by the National Natural Science Foundation of China(Grant No.61473281)the National Sciences and Technology Support Project(Grant No.2015BAI01B13)State Key Laboratory of Robotics Self-plan Project(Grant No.2016-Z06)
文摘In the wireless power transfer system for freely moving biomedical implants,the receiving unit was generally inefficient for the reason that its design parameters including the receiving coil's dimension and receiving circuits' topology were always determined by experiments.In order to build the relationship between these parameters and the total transfer efficiency,this paper developed a novel efficiency model based on the impedance model of the coil and the circuit model of the receiving circuits.According to the design constraints,the optimal design parameters in the worst case were derived.The results indicate that the combination of the two-layered receiving coil and half-bridge rectifier has more advantages in size,efficiency and safety,which is preferred in the receiving unit.Additionally,when the load resistance increases,the optimal turn number of the receiving coil basically keeps constant and the corresponding transmitting current and total efficiency decrease.For 100 Ω load,the transmitting current and total efficiency in the worst case were measured to be 5.30 A and 1.45% respectively,which are much better than the published results.In general,our work provides an efficient method to determine the design parameters of the wireless power transfer system for freely moving biomedical implants.
