Accurate diagnosis of pancreas divisum by linear-array endoscopic ultrasonography.

Background And Study Aims: During linear-array endoscopic ultrasonography (EUS), the main pancreatic duct can be followed continuously from the major papilla into the pancreatic body in most patients. Often, the duct can also be seen crossing a sonographic border between the ventral and dorsal pancreatic anlagen. It was hypothesized that the presence of either feature excludes pancreas divisum, whereas the absence of these features suggests complete pancreas divisum.

ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla.

Background: ERCP by means of long-limb Roux-en-Y surgical anastomoses has been reported primarily in patients with biliary or pancreatic anastamoses, but rarely in patients with an intact papilla.

Methods: All ERCP procedures attempted over a 6-year interval in patients with Roux-en-Y gastrojejunostomies and an intact papilla were reviewed. Patients with a prior Billroth II operation or alteration of the major papilla were excluded.

Dilation of high-grade pancreatic and biliary ductal strictures with small-caliber angioplasty balloons.

Background: Pancreatic and bile duct strictures may be too stenotic to allow passage of conventional endoscopic dilators.

Methods: Four patients with strictures (3 pancreatic, 1 biliary) that could not be traversed with conventional endoscopic dilating devices, or in 1 case by a Soehendra stent extractor, underwent stricture dilation with a 3.3F peripheral angioplasty balloon to a maximum diameter of 6 mm.

A randomized, controlled trial of interactive, multimedia software for patient colonoscopy education.

The purpose of our study was to assess the effectiveness of computer-assisted instruction (CAI) in patients having colonoscopies. We conducted a randomized, controlled trial in large, multispecialty clinic. Eighty-six patients were referred for colonoscopies.

A randomized, controlled trial of transcutaneous carbon dioxide monitoring during ERCP.

Background: Pulse oximetry, used to monitor oxygen saturation during endoscopy, does not directly measure hypoventilation. Study goals were to determine whether transcutaneous carbon dioxide (PtcCO(2)) monitoring during endoscopic retrograde cholangiopancreatography (ERCP) prevents severe hypoventilation and to assess the accuracy of clinical observation and pulse oximetry in detecting hypoventilation.

Methods: All patients received intensive clinical and electronic monitoring including pulse oximetry.

Insertion, efficacy, and removal of a nonendoscopically removable percutaneous endoscopic gastrostomy (PEG) tube.

Background: Externally removable PEG tubes require an internal bumper that can collapse to a size that is small enough to allow for its removal through the abdominal wall by external traction. Adequate force must be maintained to avoid accidental dislodgement of the tube prior to its desired removal.

Methods: A nonendoscopically removable PEG (Inverta-PEG, Ross Products Division, Abbott Laboratories, Columbus, OH, USA) was evaluated in a nonmasked, prospective clinical study involving 131 patients enrolled by 25 physicians.

The minimal standard terminology for digestive endoscopy: introduction to structured reporting.

The wider use of computers for the management of endoscopic data and the use of electronic endoscopes for the production of high quality endoscopic images has made the standardization of terminology and images formats necessary in digestive endoscopy reports. The European Society for Gastrointestinal Endoscopy and the American Society for Gastrointestinal Endoscopy have combined their efforts to propose a Minimal Standard Terminology for Computerized Databases in Endoscopy. This terminology is based on the following principles: no term describing findings less frequent than 1%, of the daily practice, and no term based on subjective impressions.

Evaluation of post-ERCP pancreatitis: potential causes noted during controlled study of differing contrast media. Midwest Pancreaticobiliary Study Group.

Background: Possible sources of post-ERCP pancreatitis were evaluated during a prospective, randomized, controlled study comparing different contrast media.

Methods: A total of 1979 patients were randomized and subdivided into groups during the study. Patients were grouped for comparison depending on the type of procedure performed during ERCP.

Group I: choosing the appropriate method of placement of an enteral feeding tube in the high-risk population.

The traditional nasogastric/nasoenteric feeding tube is the preferred access device for short-term feeding (< 30 days), with delivery into the stomach suggested unless aspiration or motility abnormalities are present. Preference for a long-term access device is operator- and facility-dependent. Endoscopic or fluoroscopic placement is preferred as first choices over laparoscopic placement because of considerations of cost, need for general anesthesia, and need for operating room time.

A comparison of nonionic versus ionic contrast media: results of a prospective, multicenter study. Midwest Pancreaticobiliary Study Group.

Background: Pancreatitis is one of the most common complications associated with ERCP. Multiple factors have been implicated for this potentially serious complication. Numerous suggestions for minimizing risks at ERCP have been offered, one of which is to use nonionic, low osmolarity contrast agents for pancreatic injection.

Fluoroscopy is not necessary for Maloney dilation of chronic esophageal strictures.

The use of fluoroscopic guidance for Maloney dilation is controversial. In order to determine if fluoroscopic analysis would enhance the success of dilation and increase recognition of adverse events, we prospectively studied 125 Maloney dilations in 80 patients (mean age, 69.3 years) with mild esophageal strictures.

Objective evaluation of competence: technical skills in gastrointestinal endoscopy.

Documentation of an individual trainee's competence in gastrointestinal endoscopy has relied on the opinion of supervisors. Recommendations about the minimum number of procedures required to attain technical competence has relied on expert opinion. Recently, objective data about procedural competence have been collected.

Carbon dioxide retention and oxygen desaturation during gastrointestinal endoscopy.

Background: Pulse oximetry measures arterial oxygen saturation (SpO2), not hypoventilation, which is directly reflected by increases in carbon dioxide tension.

Methods: In the present study, transcutaneous carbon dioxide tension (PtcCO2) and SpO2 were measured during 101 endoscopic procedures selected for long duration or comorbid illnesses, and relationships between hypercapnia and hypoxemia were evaluated. Nasal oxygen was administered only for sustained desaturation (SpO2 < 90%).

The non-bleeding visible vessel versus the sentinel clot: natural history and risk of rebleeding.

Non-bleeding visible vessel and sentinel clot are terms used interchangeably to describe protuberances in the base of ulcers that have recently bled, but a consensus as to their definition or natural history does not exist. In patients with severe ulcer hemorrhage, non-bleeding protuberances were classified as vessels, with or without a small attached clot, or as sentinel clots, according to a schema based on the appearance of the protuberance at endoscopy but not subjected to pathologic correlation. Endoscopic therapy was not performed at the index endoscopic evaluation, and natural evolution was prospectively documented with daily videoendoscopy.

Objective evaluation of endoscopy skills during training.

Objective: To evaluate the number of supervised gastrointestinal endoscopic procedures required to achieve initial competency using a simple objective grading system.

Design: Prospective, cross-sectional study.

Setting: A gastroenterology and surgical training program at a large, university-affiliated county hospital.